🛡️ Denial Management & Appeals

Denial Management That Recovers Revenue and Prevents Future Denials

✓ Sub-3% Denial Rate✓ 95% Appeal Success✓ Root Cause Analysis✓ Systematic Prevention
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Overview

Claim denials are the single largest source of preventable revenue loss in healthcare. The average provider experiences a 5-10% denial rate, yet 65% of denied claims are never appealed and 90% of denials are preventable with the right systems.

Rafsons Med Billing denial management program takes a two-pronged approach: aggressively recovering denied revenue through expert appeals, while simultaneously eliminating denial root causes through systematic prevention protocols. Our clients achieve sub-3% denial rates and 95%+ appeal success rates.

We do not just appeal denials. We study them, categorize them, and implement the billing, coding, and workflow changes needed to prevent them from recurring.

Key Benefits & Outcomes

📉

Sub-3% Denial Rate

Our systematic prevention protocols drive denial rates below 3%, versus the industry average of 5-10%.

⚔️

95% Appeal Success Rate

Expert appeals with complete clinical documentation achieve industry-leading 95%+ reversal rates.

🔍

Root Cause Analysis

Every denial is categorized by root cause: eligibility, coding, authorization, medical necessity, or timely filing.

🛡️

Prevention Protocols

Identified root causes are addressed with process improvements that prevent the same denial from recurring.

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Denial Trend Reporting

Monthly denial analytics identify payer patterns, code-level issues, and provider-specific trends.

⏱️

Timely Filing Protection

We track all filing deadlines and appeal windows to ensure no claim is ever lost to timely filing limitations.

Our Process

1

Denial Capture & Categorization

All denials are captured from ERA/EOB and categorized by denial reason code, payer, provider, and service type.

2

Root Cause Analysis

Each denial category is analyzed to identify systemic causes: incorrect codes, missing auth, eligibility errors, or documentation gaps.

3

Appeal Preparation

Specialized appeal letters with supporting clinical documentation are prepared within 48 hours of denial receipt.

4

Appeal Submission & Tracking

Appeals are submitted within payer appeal windows with certified tracking and status monitoring.

5

Prevention Implementation

Root cause findings drive process improvements in coding, eligibility checks, auth workflows, and documentation standards.

Frequently Asked Questions

What types of denials can you appeal?+
We appeal all denial types: medical necessity, coding errors, authorization required, timely filing, duplicate claims, coordination of benefits, patient eligibility, and bundling or unbundling denials. We also handle Level I, Level II, and external review appeals.
How long does the appeals process take?+
Most commercial payer appeals resolve in 30-60 days. Medicare appeals can take 30-90 days at the redetermination level. We track all appeals and escalate through ALJ and beyond when necessary.
Can you recover denials that are more than 6 months old?+
Yes. We frequently recover denials that are 12-24 months old through late filing exceptions, corrected claims, and formal appeals. Our team knows exactly which arguments are most effective for aged denials.
How do you prevent future denials?+
Prevention is built into our process. Every denial category identified triggers a specific prevention protocol: coding education, eligibility check workflows, documentation templates, authorization checklists, or payer rule updates in our billing system.

Recover Your Denied Revenue Now

Get a free denial rate analysis and discover how much revenue you are losing to preventable denials.

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