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Today we’re getting serious about something that silently chips away at your revenue, frustrates your staff, and leaves your bottom line looking weaker than it should be: claim denials.
Because here’s the truth: the average practice loses thousands—sometimes hundreds of thousands or even millions—each year to preventable denials. But these aren’t just billing department headaches. They’re indicators of broken processes that are costing you real money. And, in many cases, physician owners are completely unaware of how much money their practice is actually losing. We see a lot of groups where the billing team is resigned to having to write off claims, rather than doing the work to create systems and workflows to maximize collections. Billers are either tired, overworked, or simply lazy, and wind up quietly writing off thousands (if not millions) of dollars because it all seems too difficult, or they’re not incentivized to figure it out.
Don’t get me wrong – the insurance industry is incredibly complex, and billing rules and denial reasons frequently seem completely illogical. Many of them are. And, I would assert that as a hard-working physician, you should still get paid.
So, in today’s episode, we’re going to walk through the top 5 most common reasons your claims get denied. Then we’ll look at operational fixes for each one—concrete changes you can make in your practice to stop the revenue leaks. I’ll also estimate how much your practice can recoup by addressing each issue. From there, we’ll talk about what it takes to build a high-performing billing team with strong leadership and standardized workflows. And finally, we’ll talk KPIs—the key metrics you should be watching—and wrap up with some ideas for incentive plans that will keep your revenue cycle team motivated and focused.
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