Recovery and appeals
Denial Management and A/R Recovery, Worked to a Decision
Root-cause denial work and aged receivable recovery, with appeals written to the payer policy that caused the denial.
The short version
Denial Management & A/R Recovery without the guesswork
Roughly two thirds of denied claims are recoverable, and a little over half are never resubmitted at all. That gap is not a knowledge problem. It is a capacity problem: denials arrive faster than a front desk can work them, so the oldest ones quietly time out.
We treat a denial as an open case with an owner, a payer policy reference and a deadline. And because fixing one claim is worth far less than fixing the pattern behind it, every denial is coded to a root cause and reported back so the same failure stops recurring.
Why this matters
Why denials stay denied
The reasons are almost always operational rather than clinical. These five account for most of the balance we recover.
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Nobody owns the work queue
Denials that belong to everybody belong to nobody. Without named ownership, the queue becomes an archive.
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Appeals written as form letters
A generic appeal invites a generic upholding. Payers respond to their own policy language, cited specifically.
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Timely filing deadlines missed
Appeal windows run from 30 to 180 days depending on the payer. Missing one converts a recoverable claim into a write-off.
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Root causes never identified
If a denial is fixed but not classified, the front-end process that caused it keeps producing more of the same.
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Small balances written off by default
A blanket rule that anything under a threshold is not worth chasing can quietly surrender a significant annual sum.
Scope of work
What recovery work includes
Everything below is in scope from day one. Nothing here is an upsell later.
Root-cause classification
Every denial is tagged to a cause category: eligibility, authorization, coding, documentation, filing or contract.
Policy-cited appeals
Appeals quote the payer medical policy, contract clause or coding guideline that makes the claim payable.
Aged A/R triage
Balances are worked by bucket and by recoverability, prioritizing claims nearest their filing deadline.
Underpayment recovery
Allowed amounts are compared against your contracted fee schedule to find silent partial payments.
Payer escalation
When written appeals stall, we escalate through provider representatives and formal reconsideration channels.
Write-off governance
Nothing is written off without a documented reason and, above your threshold, without your sign-off.
Workflow
Our denial workflow
The same sequence runs every day, which is what makes the output predictable.
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1
Daily denial capture
Denials and zero-pays are pulled from remittances every day rather than discovered at month end.
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2
Triage and classification
Each denial is categorized by root cause and scored for recoverability and deadline urgency.
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3
Evidence assembly
We gather the note, authorization record, eligibility response and any prior correspondence before drafting.
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4
Appeal drafting
The appeal cites the specific payer policy or coding guideline that supports payment, with evidence attached.
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5
Submission and tracking
Appeals are logged with a follow-up date. Nothing waits on the payer without a scheduled check-in.
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6
Escalation
Unanswered or upheld appeals move to second-level reconsideration or external review where the contract allows.
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7
Pattern reporting
Monthly reporting shows which causes are growing, so the fix moves upstream to registration or coding.
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8
Front-end correction
We change the process that produced the denial, then measure whether that category actually falls.
Questions
About Denial Management & A/R Recovery
What practices usually want to know before handing this part of the revenue cycle over.
Ask us something elseThat depends on each payer timely filing and appeal window. We audit your A/R first and tell you plainly what is still actionable, what needs an exception request, and what is genuinely closed.
Legacy A/R recovery is usually quoted separately from ongoing billing, because it is finite project work with a different effort profile. You will see both lines clearly before you sign anything.
Industry initial denial rates commonly sit between five and ten percent. Under a mature process we target the low end of that range, with the more meaningful measure being how much of it we overturn.
How it works
How working with us actually starts
No long implementation project, no switching systems. Four steps, and most practices are live inside a month.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Want a read on your denial management and A/R recovery?
We will review a sample of your claims and come back with what we found. No cost, no commitment, and the findings are yours regardless of what you decide.