Stop Losing Revenue to Preventable Claim Rejections
Industry denial rates average 15%. Best-performing labs achieve under 5%. The difference is catching problems before claims go out.
The Real Cost of Denials
Staff time, follow-up calls, resubmissions
Many denied claims are written off entirely
Denials extend your revenue cycle significantly
Top 5 Denial Causes (And How to Prevent Them)
Solution: Validate at order entry before the sample is processed. OCR and field validation catch missing patient info, invalid DOB formats, and incomplete insurance data.
Solution: Real-time eligibility verification before testing. Flag patients with no active coverage or policy limitations that affect the ordered tests.
Solution: ICD-10 validation at order entry. Verify codes are valid, appropriate for the test, and meet medical necessity requirements.
Solution: Prior authorization alerts at order entry. Identify tests requiring pre-approval and flag orders before processing.
Solution: Duplicate detection in billing system. Catch resubmissions for tests already billed or bundling issues.
Our Approach to Denial Reduction
Denial Root Cause Analysis
We analyze your denial data to identify the specific causes affecting your lab. Different labs have different denial profiles.
Upstream Validation Design
We design validation rules that catch problems at order entry—before samples are processed and claims are generated.
Payer Rule Integration
We configure your systems with payer-specific rules for medical necessity, prior authorization, and coverage policies.
Workflow Optimization
We streamline the process for handling flagged orders so legitimate tests aren't delayed while issues are resolved.
Typical Results
| Metric | Before | After | Improvement |
|---|---|---|---|
| Denial rate | 15-20% | 4-6% | 60-70% reduction |
| Days to payment | 90-120 days | 45-60 days | 50% faster |
| Rework hours/week | 40+ hours | 10-15 hours | 65% reduction |
| Clean claim rate | 75-80% | 92-95% | +15-20 points |
Ready to Reduce Your Denial Rate?
Start with a denial analysis to understand exactly where revenue is leaking. We'll identify specific causes and recommend targeted solutions.
Schedule a Billing Assessment