Denial Management Services
Work the denial, then kill the reason it happened.
Roughly two thirds of denied claims are recoverable, and a large share of them are never reworked at all. Not because the practice does not care, but because reworking a denial takes as long as filing a new claim and the new claims keep coming.
There are two jobs here and most billing operations only do the first. Working the denial gets this claim paid. Root-cause analysis stops the next forty. We do both, and the second one is what actually moves your numbers.
The problem
Where this usually goes wrong
Denials pile up unworked
A denial takes real time to research, correct and appeal. When the same person is also submitting new claims, the denial queue is always the thing that waits.
The same denial keeps coming back
If nobody groups denials by reason code and payer, you fix them one at a time forever instead of fixing the pattern once.
Timely filing runs out
Appeal windows are short and payer-specific. A denial that sits for 60 days may be unappealable by the time anyone opens it.
What is included
- Every denial worked within 48 hours of receipt
- Corrected claim resubmission where the fix is administrative
- Written appeals with clinical documentation where the fix is medical necessity
- Reason-code analysis grouped by payer, provider and CPT
- Timely filing calendar so no appeal window closes unworked
- Payer policy research when a denial reflects a rule change
- Front-end fixes pushed upstream into coding and eligibility
- Monthly denial report with the top five root causes and what changed
How it runs
Our process
- 1
Triage
Denials sorted daily into administrative fixes, clinical appeals, and true non-covered. The split matters because each needs a different person and a different clock.
- 2
Rework and appeal
Administrative corrections go back the same week. Clinical appeals get a written letter with supporting documentation attached, not a resubmission and a hope.
- 3
Root-cause coding
Every denial is tagged with why it happened, not just the payer reason code. Reason code CO-97 tells you it was bundled. The tag tells you which modifier was missing and who missed it.
- 4
Upstream fix
The tag drives a change at the source: an eligibility check that was skipped, a modifier rule the coder needs, a template that does not capture medical necessity.
- 5
Monthly review
Top five root causes, the volume behind each, what we changed, and what still needs a decision from you.
Denial handling before and after
| Metric | Billing in house | With AsesorMD |
|---|---|---|
| Denials reworked | The urgent ones, when there is time | All of them, within 48 hours |
| Appeal letters | Rare, usually a resubmission instead | Written, with documentation attached |
| Root-cause tracking | None | Tagged and reported monthly |
| Repeat denial rate | Same reasons every month | Top causes eliminated one by one |
| Timely filing losses | Happens quietly | Calendar-tracked, zero target |
Questions we get asked
What percentage of denials are actually recoverable?
Industry-wide, most denials are appealable and a majority of appealed denials are overturned. The real constraint is not whether they can be won, it is whether anyone has time to work them before the filing window closes.
How fast do you work a denial?
Within 48 hours of it appearing in the ERA. Speed matters most for appeal deadlines, which vary by payer and can be as short as 30 days from the denial date.
Do you handle clinical appeals or just administrative?
Both. Administrative corrections are the volume. Clinical appeals are where the dollar value is, and they need a written letter citing the documentation, which is why they are the ones most often skipped.
Can you work our existing backlog of old denials?
Yes, and we usually start there. Some of the backlog will be past timely filing, but the recoverable portion is typically the fastest visible win in the first two months.
How do we know it is working?
Your denial rate and your repeat-denial rate. If we are only working denials and not eliminating causes, the first number moves and the second does not. Both are in the monthly report.
Is denial management available on its own?
Yes. Some practices keep submission in house and hand us only the denial queue, which is the piece that most often goes unworked.
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com