Services
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. Ageing A/R is the same problem measured in months. Both are recoverable, and both respond to method rather than effort.
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. Denials caused by front-office data, denials caused by coding, and denials caused by payer policy need three different responses, and only one of the three is worth appealing claim by claim.
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, because appealing them one at a time is expensive and they will keep arriving. Coding-driven denials get reviewed against the documentation and corrected. 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, they may belong in the dispute process instead.
Ageing accounts receivable get the same 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 where the recoverable money usually 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.
Denial Management & Appeals
Denials classified by CARC code and cause, then fixed at source or appealed on the record.
About Denial Management & AppealsA/R Follow-Up & Collections
Insurance A/R worked by age and value, oldest and largest first, with every payer contact documented.
About A/R Follow-Up & Collections
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 billing 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
Complete solutions
End-to-End Revenue Cycle Management
Every service we offer, run as one engagement, from registration through to disputes.
About End-to-End Revenue Cycle ManagementER Billing Services
Emergency department revenue cycle: high volume, high out-of-network exposure, unpredictable payer mix.
About ER Billing ServicesUrgent Care & Clinic Billing
Walk-in volume, mixed payers and thin admin capacity, billing built for how urgent care actually runs.
About Urgent Care & Clinic Billing
Start with a free billing 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.