From Burnout to Bottom Line:
Why Outsourcing Coding Is a Smarter Move
Every dollar matters in today’s healthcare landscape, yet too many organizations are losing revenue to preventable denials.
Recent data shows that 84% of claim denials are avoidable, and 22% are entirely unrecoverable due to front-end mistakes like missing prior authorizations or eligibility errors.
These issues don’t just slow down cash flow-they add administrative burdens, increase compliance risks, and threaten your practice’s financial stability.
With regulatory requirements evolving and AI-assisted coding becoming the norm, healthcare leaders can no longer rely on reactive claim management. Proactive denial prevention, documentation accuracy, and financial optimization are now essential for sustainable growth.
Here we will outline five actionable revenue cycle management (RCM) fixes to help your organization reduce denials, maintain compliance, and maximize reimbursement-ensuring a more resilient and profitable practice.
Strengthen Front-End Processes to Prevent Denials
Most denied claims can be traced back to errors made before care is delivered. In fact, front-desk mistakes account for nearly half of all denials, with registration and eligibility issues leading the way. By tightening front-end processes, you can ensure cleaner claims and faster payments.
Take Action:
- Conduct regular audits to catch front-desk errors before they impact claims.
- Set clear performance standards for registration and eligibility verification.
- Provide ongoing training for staff on pre-authorizations and insurance checks.
- Use standardized checklists for eligibility, copay collection, and patient data accuracy.
- Ready to eliminate costly denials? Schedule a front-end process review with our RCM experts.
Improve Clinical Documentation to Minimize Errors
Incomplete or inaccurate documentation is a leading cause of claim denials and payment delays. Providers must ensure that encounter notes fully support billed services, clearly documenting the medical necessity and specifics of each visit.
- Encourage providers to treat each note as a standalone document.
- Use precise diagnostic codes, avoiding unspecified or default options.
- Clearly document anatomical sites, causal relationships, and treatment necessity.
- Train coding teams to proactively identify and address documentation gaps.
- Let us help your team master documentation best practices-contact us for a customized training session.CONTACT MARK TODAY – 706.315.4660
Establish Clear Performance Benchmarks
Without defined benchmarks, revenue cycle teams lack direction and miss opportunities for improvement. Tracking key metrics helps identify bottlenecks and drive strategic decisions that boost financial performance.
Key Metrics to Monitor:
- Days in Accounts Receivable (A/R): Industry standard is 40–50 days; over 60 signals a problem.
- Percentage of Rejected Claims: Reveals front-end processing issues.
- Percentage of Denied Claims: Highlights coding, billing, or documentation problems.
- Curious how your metrics stack up? Request a complimentary RCM performance analysis today.
Prioritize Rejected and Denied Claims
Not all denials are created equal. High-value claims or those nearing deadlines require immediate attention. An internal workflow for claim prioritization can maximize recoveries and minimize lost revenue.
- Set internal deadlines for resolving rejected claims (within 24–48 hours).
- Run daily reports to monitor rejected and denied claims.
- Prioritize high-dollar claims and those close to timely filing limits.
- Review explanation of benefits (EOBs) for partial payment issues.
- Streamline your denial management-ask us about automated claim tracking solutions.
Recognize the True Cost of Denials
Denied claims don’t just impact revenue-they also drive-up administrative costs. Reworking a single claim can cost between $25 and $117, and many denials are never recovered due to preventable errors. A strong RCM strategy saves both time and money.
Key Takeaways:
- 84% of denials can be avoided with robust front-end processes and documentation.
- 22% of denials are unrecoverable due to missing authorizations or eligibility issues.
- Proactive auditing and staff training can significantly reduce rework costs.
- Stop leaving money on the table.
- Connect with the MMS team to build a denial prevention plan tailored to your practice.
Ready to Ditch the Coding Burden?
Don’t let the myth of “free” coding drag down your practice. Let us help you recover lost revenue, reduce compliance risk, and take the pressure off your physicians.
📞 Schedule a call today 706.315.4660 and let’s talk about how our coding experts can make a real difference in your practice.
Disclaimer: This information is for education purposes only, and is not intended to be a substitute for specific individualized tax, legal, or investment advice. Where specific advice is necessary or appropriate, you should consult with a qualifies tax advisor, Financial Planner or CPA.
For assistance managing and improving your Revenue Cycle, contact Mark Manning of Medical Management Services at 706.315.4660.
