Introduction
Claim denials are one of the biggest frustrations for healthcare providers—and one of the biggest threats to cash flow. Most practices don’t lose revenue because they aren’t seeing enough patients. They lose revenue because claims are delayed, denied, or never followed up properly.
The good news? Most denials are preventable.
At Acuity Health Solutions, we work with practices every day to identify where revenue is leaking and fix it at the source. Below are practical medical billing best practices that help reduce denials, speed up reimbursements, and keep cash flowing consistently.
Many denials happen before the claim is even submitted.
1. Start With Accurate Eligibility Verification
Best practices include:
- Verifying insurance eligibility before every visit
- Confirming coverage type (medical vs prescription vs supplemental)
- Checking deductibles, copays, and benefit limitations
- Identifying plans that require referrals or prior authorizations
Eligibility should never be treated as a one-time setup. Payer plans change often, and re-verification protects both revenue and patient satisfaction.
2. Don’t Treat Prior Authorizations as Optional
Missing or incorrect authorizations are among the top denial reasons across specialties like ophthalmology, infusion therapy, and surgery centers.
To reduce authorization-related denials:
- Track authorizations by CPT code and payer
- Monitor expiration dates and visit limits
- Ensure documentation matches the approved services
- Keep authorization proof readily available for appeals
A strong authorization workflow can significantly reduce rework and lost revenue.
3. Focus on Clean Claims the First Time
Submitting clean claims is one of the fastest ways to improve cash flow.
Best practices include:
- Using specialty-specific CPT and ICD-10 codes
- Applying correct modifiers based on payer rules
- Ensuring provider NPI, taxonomy, and place of service are accurate
- Reviewing claims for common formatting and data errors
Every rejected claim adds days—or weeks—to your revenue cycle. Getting it right the first time matters.
4. Address Denials Proactively, Not Reactively
Denials should never be handled randomly or in isolation.
Effective denial management means:
- Categorizing denials by reason (eligibility, authorization, coding, medical necessity)
- Identifying recurring payer patterns
- Appealing high-value and systematic denials promptly
- Updating workflows to prevent repeat issues
Denials are data. Practices that analyze them consistently recover more revenue and reduce future errors.
5. Keep Accounts Receivable Moving
A growing AR balance is a warning sign, even if collections look steady.
To keep AR under control:
- Follow up on unpaid claims within payer-specific timelines
- Prioritize high-dollar and aged claims
- Avoid letting claims cross the 90-day mark
- Escalate stalled claims before they become write-offs
Healthy cash flow depends on disciplined and consistent AR follow-up.
6. Make Documentation and Coding Work Together
Coding accuracy depends heavily on clinical documentation.
Best practices include:
- Regular communication between providers and billing teams
- Ongoing coding audits and education
- Ensuring documentation clearly supports medical necessity
- Staying current with annual coding updates
When documentation and coding are aligned, denials decrease and compliance risks are minimized.
7. Track the Right Metrics
You can’t improve what you don’t measure.
Key metrics every practice should monitor:
- First-pass claim acceptance rate
- Denial rate by payer
- Days in accounts receivable
- Net collection rate
These numbers provide early warning signs and help leadership make informed decisions before revenue is impacted.
8. Consider Expert Support When Needed
As billing rules become more complex and staffing becomes harder, many practices struggle to keep everything in-house.
Working with an experienced RCM partner can help:
- Reduce denials through specialized expertise
- Improve cash flow consistency
- Maintain compliance with payer and regulatory changes
- Free up staff to focus on patient care
The goal isn’t just billing claims—it’s collecting what you’ve earned.
Final Thoughts
Reducing claim denials isn’t about working harder. It’s about tightening processes, paying attention to details, and addressing issues early in the revenue cycle.
Practices that follow these Medical Billing Best Practices see:
- Faster reimbursements
- Fewer write-offs
- More predictable cash flow
- Less operational stress
At Acuity Health Solutions, we help practices turn billing from a constant challenge into a reliable revenue engine.
