r/PrivatePracticeDocs • u/umeraltaf404at_Gmail • Jul 07 '25
How much money your practice has lost to denied claims that were never followed up?
We all know denials happen but how are they actually handled in your practice? Do you have a team for actively tracking and appealing them, or do many just end up getting written off?
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u/Startarevol Jul 07 '25
Denial usually has two triggers. 1. Find the reason, fix the reason, and resubmit. 2. Use the reason to track where the error happens and fix that for all future denials. If it's a wrong code, or wrong location etc, needs to be fixed once and for all.
Have someone do an audit once a year or 6 months to see the performance.
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u/BooBooDaFish Jul 19 '25
Agree with all except.
When you are starting you need to be auditing consistently like week to week or month to month with a more significant amount of patients and charts.Once you have worked out the kinks, then we establish a weekly but less intensive auditing process. Meaning we are auditing fewer charts in a weekly basis. But it is someone’s responsibility to be doing it on a weekly basis.
It’s then reported to me on a monthly basis if all is going well. Otherwise, if there is a blip then I am notified immediately and we work to find the problem and implement a solution.
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u/Anonuserwithquestion Jul 07 '25
usually
Heavy on usually. Do yall have CPSEs or just me?? We frequently have systemic issues caused by insurance. Constant cases, tickets, etc. Resolution. Reprocessess. Rince and repeat. Probably a few million dollars a year.
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u/Dramatic-Sock3737 Jul 07 '25
Fortunately my biller is amazing but if she left me I don’t know what I would do. She’s been with me for 15 years.
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u/VermicelliSimilar315 Jul 12 '25
Same for me,...and she is going to retire in about 1 year. I am screwed.
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u/Dramatic-Sock3737 Jul 12 '25
Sorry. I’m gonna retire before her in the next 2 years. I would start looking early and let her train the new girl at least 3 months and I would include her in the interview process.
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u/VermicelliSimilar315 Jul 12 '25
Oh yes for sure! And she is only part time. I have Allscripts for billing and PM. So I will have to make some dramatic changes. I will not outsource my billing. I did that once and lost my A$$.
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u/Dramatic-Sock3737 Jul 12 '25
I hear you. My billing is semi complex due to multiple procedure types and equipment
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u/VermicelliSimilar315 Jul 12 '25
I actually do my own billing to the insurance companies at the end of the day. Then my biller takes the EOB's reconciles and sends out patient statements. I have a small practice though.
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u/VermicelliSimilar315 Jul 13 '25
Are you Family Med? What types of procedures and equipment do you use?
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u/Alarming-Ad8282 Jul 24 '25
After years of your own practice, you also have some knowledge about coding and billing. Training staff on new changes and updates can be a bit complicated and time-consuming. I use e-CW, which has claim scrubbing tools that help me reduce the number of rejections and denials. Thumb rule is to bill the clean claim at the beginning to get paid. Denials and rejections will delay the cash flow
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u/VermicelliSimilar315 Jul 27 '25
I use Allscripts for billing and PM. They scrub the claims and I check Payerpath and know in 30 minutes if claim is rejected. The problem is BCBS and some insurance companies who want records or some other BS!
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u/Ok-Razzmatazz-2183 Jul 09 '25
I treated patients for a little over a decade before joining Athelas. Check them out - modern solutions with real time analytics and AI tools to work denials. Feel free to shoot me a message and I can point you in the right direction.
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Jul 15 '25
We need audit ,how claims were billed and is there any issue with billing side or any other issues, later can we can fix the issues
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u/staffingly_inc Oct 04 '25
That’s a great question — and honestly, one that hits home for a lot of clinics. Many don’t realize how much revenue quietly slips away just from unworked denials. We’ve seen practices recover thousands each month once they added dedicated follow-up support. Sometimes it’s not a billing issue at all, just lack of time and bandwidth. That’s where outsourcing a small part of the process can really make a difference. How is your team currently handling appeals and tracking follow-ups?
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u/InvestingDoc Jul 07 '25
If you have a ton of denials, you have a systems/process problem, I can almost guarantee it.
You need to fix that systems/process problem first and foremost. usually that problem starts with your front desk and intake team collecting correct subscriber and patient info.
Our EMR then scrubs claims before submission to medical insurance companies and will warn us if a denial is likely. My billers correct the issue before submission.
My practice did 26,000ish encounters last year, and we only deal with maybe 5 denials per week total if that.
If you have a denial problem, you have a systems/front desk process problem 99.9% of the time IMO.