The Denial Trap: Why Your Claims Keep Failing and What to Do Next
You’ve submitted the claims. You’ve waited. And then… the dreaded denial. For most practices, denied claims are a daily frustration — but too often, they’re quietly draining revenue without anyone realizing how much is actually being lost.
Let’s talk about why these denials are happening, how to fix them, and what it’s costing you if you don’t.
1. Denials Are Not a Billing Problem — They’re a System Problem
Most practices treat claim denials like isolated events. A code here. A modifier there. But denied claims often reveal deeper workflow or credentialing breakdowns — not just billing issues.
Common root causes I find during audits:
- Providers aren’t properly credentialed (or haven’t been updated and or linked to the billing group)
- Claims were submitted before prior authorizations were obtained
- Staff are using outdated coding templates or rules
- Payers change their edits — and no one’s tracking the patterns
If your denial rate is over 5–7%, you’re likely leaving money on the table.
2. The Real Cost of “We’ll Just Resubmit”
Here’s the thing: resubmitting denied claims is manual, messy, and massively under-prioritized. It’s not just time — it’s delayed cash flow, higher aging A/R, and write-offs you shouldn’t accept.
I once worked with a midwife-led clinic that had 4 months of denials sitting untouched (stuffed in a drawer) because no one “owned” them. We recovered over $40,000 in under 60 days — just by creating a system to track, correct, and resubmit.
3. So, What Can You Do?
Here are three steps any practice can start with right now:
✅ Run a denial reason report — Sort by payer and category. Ask yourself if denials are related to eligibility, coding, or auths?
✅If your practice management aka billing software can’t run this report for you, you may have bigger problems to consider first.
✅ Audit your top 10 most-denied CPT codes — Look at patterns. Are they denied for missing info? Timely filing?
✅ Assign denial ownership — Whether it’s your in-house biller or outsourced partner, someone should own the resolution process.
If you’re not already tracking and trending denials monthly, that’s your first step.
4. Bonus Tip: Denials Reveal More Than You Think
Your denial data can tell you where to train staff, where payers are changing policies, and even where your workflows are breaking down. They’re not just problems — they’re insight.
If you’re swimming in denials and not sure where to begin, I’d be happy to review a sample and help identify where things are getting stuck.
👉 Get in touch here: https://marniecabezas.com/contact – let’s fix what’s costing you money.