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HMT Billing Solutions

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Money You Have Already Earned, Still Sitting With the Payer

A denial is not a decision. It is the start of a conversation most practices never finish. Aging A/R is the same problem, measured in months. Both are recoverable, and both respond to method, not effort.

Why One-Size-Fits-All Denial Work Fails

The common failure in denial work is treating every denial the same way: resubmit, appeal, follow up, repeat. That approach recovers some money and teaches you nothing, because it never asks why the denial happened. We classify every denial by CARC and RARC code and by payer before deciding what to do with it:

  • Registration and eligibility failures go back to the front office as a process fix. Appealing these one at a time is expensive, and they will keep arriving until the source is fixed.
  • Coding-driven denials are reviewed against the documentation and corrected.
  • Payer policy denials, including medical necessity, bundling and out-of-network determinations, get a written appeal with the supporting record attached. Where the payer is wrong about an out-of-network rate, these may belong in the dispute process instead.

How Aging A/R Gets Worked

Aging accounts receivable get the same by-cause treatment, by bucket. Claims sitting at sixty days for want of a phone call are a different problem from claims sitting at a hundred and twenty because they were never worked, and the second group is usually where the recoverable money is. We work oldest-and-largest first, we document every payer contact, and you get a monthly report showing what moved and what did not.

A/R & Denial Recovery

Services in This Group

Sold individually or bundled. Most engagements combine two or three.

FAQ

Questions We Get Asked

Will you work our existing old A/R, or only new claims?

Both, and legacy A/R is often the fastest return on the engagement. Old accounts have usually been abandoned rather than exhausted: worked once, denied, and left. Timely-filing limits do close the door on some of it, which is why the free revenue cycle audit looks at aging first: it tells us what is still recoverable before either of us commits.

How do you decide which denials to appeal?

By cause and by value. A denial rooted in a fixable process problem is worth correcting at the source rather than appealing repeatedly. A payer policy denial on a well-documented encounter is worth a written appeal. A low-value denial that will cost more to appeal than it will recover is a judgment call, and we tell you what we decided rather than quietly writing it off.

Do you handle patient balances as well as insurance A/R?

Patient billing and statements are a separate service line. Insurance A/R is what this category covers, following up with payers on claims that have been submitted and not fully paid. Many practices want both, and they are commonly bundled, but they are scoped and priced separately because the work is genuinely different.

Related

Other Services We Offer

Or take it as one engagement: End-to-End Revenue Cycle Management, ER Billing Services, Urgent Care & Clinic Billing and Hospital & Facility Billing.

Start With a Free Revenue Cycle Audit

We review a sample of your recent claims and your current A/R aging, and report where revenue is being lost. The report is yours whether or not you engage us.

Request your free auditor call +1 307-443-6998