If you’re running a medical practice, you’ve likely felt the sting of rising insurance denials and
payment delays. It’s not your imagination. Rejection rates are climbing, hitting 10-15% or more
nationwide, and some claims are languishing past 90 days, especially with Medicare Advantage
and state-managed plans. As a Certified Medical Revenue Manager, I’ve seen this trend drain
cash flow and frustrate patients across practices of all sizes. The good news? You can fight back,
and it starts with a sharper focus on your front desk. Here’s how practice owners like you can
take control and keep revenue on track.
Why Denials Are Surging & Why It Hurts
The data paints a grim picture. A 2024 survey found 75% of healthcare leaders reporting more
denials than just two years ago, driven by tighter payer policies—think prior authorizations,
coding audits, and “medical necessity” disputes. Nationally, unresolved claims cost billions
annually, with hospitals alone losing an estimated $20 billion to write-offs and rework. For
smaller practices, even a handful of rejections can tie up thousands in revenue. Worse, up to
25% of these denials stem from avoidable front-end errors—outdated insurance info, missing
pre-approvals, or data glitches. That’s not just a billing hiccup; it’s a delay in patient care and a hit
to your bottom line.
Payers argue it’s about cost control, but when a claim sits unpaid or a patient faces an
unexpected bill, the burden lands on you. The fix isn’t waiting for insurers to ease up—it’s
building a process that stops denials before they start.
Your DIY Playbook: Strengthen the Front End
The front desk isn’t just a check-in point. The front desk is your first defense against revenue
leaks. With a few tweaks and the right tools, you can turn it into a denial-fighting machine. Here’s
what works:
Pre-Visit Prep: Most practice management systems, (like NextGen Office, Tebra, eClinical Works,
Athenahealth, etc.), offer real-time eligibility checks. Run a report 24-48 hours before
appointments to pull payer data: active coverage, co-pays, deductibles, and service-specific
benefits. It flags gaps early such as lapsed plans or pre-auth needs so you’re not blindsided.
Card Check Every Time: Ask for the patient’s insurance card at every visit, no exceptions. People
switch jobs, plans renew, or patient coverage lapses. Relying on last month’s eligibility info is a
gamble. Scan it, compare it to your system’s data, and re-verify if anything seems off. It’s a quick
step that catches errors that payers love to exploit.
Benefits Breakdown: Before services kick off, confirm coverage for that day’s procedures. Does
the plan need prior authorization for high-ticket items? Are there exclusions? A minute spent
here can save weeks of appeals.
Patient Clarity: Train staff to level with patients: “Your co-pay’s $25, but this might need
approval... do you want to go ahead?” Get waivers signed if coverage is shaky because it’s your
shield against post-visit disputes.
This isn’t rocket science; it’s simple discipline. Practices that tighten front-end verification see
denial rates drop by 20-30%, keeping cash flow steady and administrative headaches down.
Why It Pays Off
A solid front-end process isn’t just about dodging denials, it's more about control. When your
staff nails eligibility, claims go out clean, and payers have fewer excuses to push back. If a denial
does slip through, you’ve got documentation with dates, payer responses, and patient sign-offs
to fuel an appeal. Data shows over 50% of appealed claims can flip with the right evidence, and
that starts with what’s captured at check-in.
So, take it a step further: track your denials by payer and reason. Spot a pattern... like one
insurer rejecting 15% of claims on technicalities? Use it to renegotiate contracts or flag staff
training gaps. It’s not flashy, but it’s how you turn a losing battle into a winnable one.
The Bigger Challenge and Your Power To Overcome It
This isn’t a blip; it’s a shift. Payers are getting tougher, and patients feel the squeeze. One in five
appeals succeeds when you fight, but you shouldn’t have to. You can’t fix the system, but you
can protect your practice. A quarter of denials are preventable, and that’s where your leverage
lies. Every clean claim is revenue secured, every patient informed is trust earned.
So, private practice owners, here’s your next move: peek at your front desk tomorrow. Are cards
checked religiously? Is your software pulling its weight? Are staff empowered to catch mistakes?
Small changes here can create a big ripple effect resulting in less rework, faster payments, and
happier patients. You’ve got the tools, so tweak them, test them, and watch the numbers turn in
your favor. The denial surge is real, but it doesn’t have to sink you.
Written by: Tim W. Warren, CEO, CMRM
payment delays. It’s not your imagination. Rejection rates are climbing, hitting 10-15% or more
nationwide, and some claims are languishing past 90 days, especially with Medicare Advantage
and state-managed plans. As a Certified Medical Revenue Manager, I’ve seen this trend drain
cash flow and frustrate patients across practices of all sizes. The good news? You can fight back,
and it starts with a sharper focus on your front desk. Here’s how practice owners like you can
take control and keep revenue on track.
Why Denials Are Surging & Why It Hurts
The data paints a grim picture. A 2024 survey found 75% of healthcare leaders reporting more
denials than just two years ago, driven by tighter payer policies—think prior authorizations,
coding audits, and “medical necessity” disputes. Nationally, unresolved claims cost billions
annually, with hospitals alone losing an estimated $20 billion to write-offs and rework. For
smaller practices, even a handful of rejections can tie up thousands in revenue. Worse, up to
25% of these denials stem from avoidable front-end errors—outdated insurance info, missing
pre-approvals, or data glitches. That’s not just a billing hiccup; it’s a delay in patient care and a hit
to your bottom line.
Payers argue it’s about cost control, but when a claim sits unpaid or a patient faces an
unexpected bill, the burden lands on you. The fix isn’t waiting for insurers to ease up—it’s
building a process that stops denials before they start.
Your DIY Playbook: Strengthen the Front End
The front desk isn’t just a check-in point. The front desk is your first defense against revenue
leaks. With a few tweaks and the right tools, you can turn it into a denial-fighting machine. Here’s
what works:
Pre-Visit Prep: Most practice management systems, (like NextGen Office, Tebra, eClinical Works,
Athenahealth, etc.), offer real-time eligibility checks. Run a report 24-48 hours before
appointments to pull payer data: active coverage, co-pays, deductibles, and service-specific
benefits. It flags gaps early such as lapsed plans or pre-auth needs so you’re not blindsided.
Card Check Every Time: Ask for the patient’s insurance card at every visit, no exceptions. People
switch jobs, plans renew, or patient coverage lapses. Relying on last month’s eligibility info is a
gamble. Scan it, compare it to your system’s data, and re-verify if anything seems off. It’s a quick
step that catches errors that payers love to exploit.
Benefits Breakdown: Before services kick off, confirm coverage for that day’s procedures. Does
the plan need prior authorization for high-ticket items? Are there exclusions? A minute spent
here can save weeks of appeals.
Patient Clarity: Train staff to level with patients: “Your co-pay’s $25, but this might need
approval... do you want to go ahead?” Get waivers signed if coverage is shaky because it’s your
shield against post-visit disputes.
This isn’t rocket science; it’s simple discipline. Practices that tighten front-end verification see
denial rates drop by 20-30%, keeping cash flow steady and administrative headaches down.
Why It Pays Off
A solid front-end process isn’t just about dodging denials, it's more about control. When your
staff nails eligibility, claims go out clean, and payers have fewer excuses to push back. If a denial
does slip through, you’ve got documentation with dates, payer responses, and patient sign-offs
to fuel an appeal. Data shows over 50% of appealed claims can flip with the right evidence, and
that starts with what’s captured at check-in.
So, take it a step further: track your denials by payer and reason. Spot a pattern... like one
insurer rejecting 15% of claims on technicalities? Use it to renegotiate contracts or flag staff
training gaps. It’s not flashy, but it’s how you turn a losing battle into a winnable one.
The Bigger Challenge and Your Power To Overcome It
This isn’t a blip; it’s a shift. Payers are getting tougher, and patients feel the squeeze. One in five
appeals succeeds when you fight, but you shouldn’t have to. You can’t fix the system, but you
can protect your practice. A quarter of denials are preventable, and that’s where your leverage
lies. Every clean claim is revenue secured, every patient informed is trust earned.
So, private practice owners, here’s your next move: peek at your front desk tomorrow. Are cards
checked religiously? Is your software pulling its weight? Are staff empowered to catch mistakes?
Small changes here can create a big ripple effect resulting in less rework, faster payments, and
happier patients. You’ve got the tools, so tweak them, test them, and watch the numbers turn in
your favor. The denial surge is real, but it doesn’t have to sink you.
Written by: Tim W. Warren, CEO, CMRM