5 Tips from RCM Experts to reduce denials
for Doctors & Practice Managers
A quick, practical playbook to tighten Revenue Cycle Management (RCM), cut rework, and recover cash fast.
Use these steps to fix what’s blocking reimbursements. If you’d rather not build it, we can run the workflow for you.
Tip #1
Build a Denied-Claim Follow-Up Board (Kanban)
You’ll build a single, visual lane for every denied claim from intake to resolution.
Get fewer stalls, clearer ownership, and faster cash recovery.
Do this:
- Create lists: Intake → Triage → Rework → Appeal Filed → Payer Response → Paid/Closed
Map the exact journey a denied claim should take, left to right, so anyone opening the board instantly knows where each claim lives, what comes next, and what “done” looks like.*
Why? A single, left-to-right path keeps claims moving and prevents them from getting “lost.”
- Add core fields on every card: Claim #, Payer, Date of Service (DOS), CPT, $ Amount, CARC/RARC, Last Touch, Next Action, SLA/Deadline Date
Put all decision-making details on the claim card itself—identifiers, codes, dollars at stake, and exactly who touched it last—so no one needs to dig through emails or EHR screens to act.*
Why? Having the right facts in one place speeds decisions and reduces back-and-forth.
- Color-label by payer and denial type (Prior Auth, Coding, Bundling, Medical Necessity)
Use colors to group similar problems (e.g., same payer or same denial reason) so trend spotting becomes visual—clusters reveal root causes you can fix upstream.*
Why? Patterns jump out so you can spot systemic issues.
- Set 30/15/7-day deadline alerts and auto-assign owners
Add timers and automatic assignments so every claim always has a name on it and a countdown clock—especially for strict filing/appeal windows.*
Why? You avoid missing filing/appeal windows that turn into write-offs.
- Use Calendar and Dashboard views for $ at risk, win rate, days to resolve
Flip between a calendar of upcoming deadlines and a dashboard of performance KPIs, so daily standups focus attention on the highest-dollar, most urgent wins.*
Why? Daily visibility drives action and focuses the team on the biggest dollars.
We can do it for you: We’ll set up the board, work denials daily, file appeals, chase SLAs, and send win-rate dashboards.
Tip #2
Create an Appeal Letter Library
Standardize your appeal responses with ready-to-use templates organized by denial reason.
Get faster drafting, higher overturn rates, and consistent payer language.
Do this:
- Make folders by denial reason: Medical Necessity, Prior Authorization, Eligibility, Bundling/NCCI, Coding/Modifiers, Timely Filing
Organize templates so staff can navigate by the reason code they see, grab the matching folder, and start from a proven draft instead of a blank page.*
Why? Staff can grab the right starting point fast—less drafting from scratch, fewer errors.
- Use a standard template structure: Claim identifiers → Payer policy citation → Point-by-point rebuttal → Attachments list
Follow a consistent persuasive flow that references the payer’s own rulebook, addresses their points directly, and clearly enumerates what evidence you’re enclosing.*
Why? Speaking the payer’s language (and citing their policy) increases overturns.
- Pre-package evidence: corrected claim, highlighted progress notes, auth/referral proof, EOB, required forms
Bundle every common exhibit up front so the first submission is complete, avoiding “pends” and re-requests that can push you past deadlines.*
Why? Complete packets get processed instead of pended.
- Add merge fields (patient/claim IDs, CPT/ICD, dates)
Turn each template into a mail-merge form so clerical data auto-fills, reducing typing, typos, and the time clinicians spend double-checking identifiers.*
Why? You can scale appeals without slowing down clinical operations.
- Build a quick guide: CARC/RARC → which template + which attachments
Create a look-up table that translates denial codes into the exact template and evidence list, so front-desk or billing staff make the right choice in seconds.*
Why? Frontline staff pick the correct response immediately.
We can do it for you: We maintain templates, assemble evidence, submit/escalate appeals, and report overturn rates.
Tip #3
Build a Root-Cause Denial Heatmap
Analyze denials to see where dollars are leaking by payer and reason.
Target the few fixes that prevent the most denials and recover the most cash.
Do this:
- Export denials with Payer, DOS, CPT/HCPCS, Provider, CARC/RARC, Denied $, Notes
Pull a data set rich enough to slice by who denied, why, for which services, and how much money was affected, plus context notes from your team.*
Why? Enough detail reveals what’s actually breaking in your process.
- Create a pivot: Rows = Payer, Columns = Reason, Values = Denied $ and Count
Summarize the data so you can see which payer-reason combinations generate the most dollars denied and how often they occur.*
Why? You’ll see the largest cash leaks first (not just the most frequent).
- Apply heatmap colors; flag the Top 10 intersections
Use conditional formatting to spotlight the worst hotspots and create a top-ten hit list that guides your next sprint.*
Why? Focus limited time where the money is.
- For each hot spot, define exactly one prevention step (e.g., add modifier 59 when appropriate, verify auth before scheduling, add a specific documentation phrase)
Attach a single, concrete prevention rule to each hotspot—an edit, checklist, or script—so teams know the exact upstream behavior to change.*
Why? Prevention beats rework and permanently lowers denial volume.
- Review monthly: assign owners and due dates
Treat the heatmap like a living dashboard—re-run it monthly, assign named owners to each fix, and track completion and impact visibly.*
Why? You get steady improvement instead of one-time cleanups.
We can do it for you: We run the analysis, deploy prevention edits, and show month-over-month denial reductions.
Tip #4
Run a First-Pass Acceptance (FPA) Audit
Check a small sample of recent claims to see where submissions fail.
Get a quick, targeted edits that raise first-pass acceptance and speed cash.
Do this:
- Sample 50 recent claims across payers and CPT families
Pull a representative mini-cohort (different payers and services) so you can learn fast without boiling the ocean.*
Why? A small, representative slice gives quick signal without heavy lift.
- Categorize results: Accepted / Rejected (clearinghouse) / Denied (payer)
Separate where failures happen—front-end edits vs payer adjudication—so fixes go to the right place (scrubber vs documentation/coding).*
Why? You’ll learn where in the pipeline claims are failing.
- Tag failure reasons: Eligibility, Auth, Coding, Modifier, NCCI, Place of Service (POS), Demographics
Label each failed claim with the specific root cause so patterns emerge and the edit you write is precise, not generic.*
Why? Clear tags point to the exact edit or checklist to add.
- Write Top 5 pre-submission edit rules (e.g., enforce modifier 25 with E/M + minor procedure; LCD/NCD coverage checks)
Add a handful of high-leverage scrubber rules tied to your findings so errors are blocked before submission, not discovered weeks later.*
Why? Cleaner claims raise FPA and accelerate cash.
- Re-audit the next 50 after changes
Run the same sampling again to confirm the FPA lift and verify you actually reduced touches and rework.*
Why? Confirms the FPA increase and fewer touches per claim.
We can do it for you: We implement payer-specific scrubs to raise first-pass acceptance and accelerate reimbursements.
Tip #5
Install a Timely Filing & Appeal Timer
Track every payer’s filing and appeal deadlines with automated countdowns and alerts.
Prevent avoidable write-offs and rescue near-expired dollars.
Do this:
- List each payer’s filing and appeal windows; auto-calculate “last day to file/appeal” from DOS or denial date
Maintain a live rules table and compute a deadline per claim automatically so staff always see the true last permissible day to act.*
Why? Stops avoidable write-offs caused by missed deadlines.
- Add a status bar: Safe / 30d / 15d / 7d / Expired with colors
Use a simple traffic-light scale so the team can triage by urgency at a glance, without reading fine print or policy PDFs.*
Why? Teams tackle expiring claims first.
- Sort the worklist daily by soonest deadline; work the 7d queue first
Make the list re-order itself every morning so staff start with claims closest to expiration for immediate, measurable wins.*
Why? Increases quick wins and real cash this week.
- Trigger email/Slack reminders at each threshold
Fire automated nudges at 30/15/7 days so owners are pinged without a manager needing to babysit the list.*
Why? No missed clocks, even during busy clinic days.
- Track saves: claims rescued, dollars recovered, expired trend
Record the number and value of deadlines you beat each week so leadership can see ROI and keep the timer practice funded and prioritized.*
Why? Proves impact and keeps urgency high.
We can do it for you: We track every deadline, submit on time, and eliminate avoidable write-offs.
What to Expect (Typical Outcomes)
- Higher First-Pass Acceptance (FPA): Cleaner claims, fewer touches.
Edits and checklists prevent known failure modes. - Faster Days in A/R: Denials worked in order of impact and urgency.
Heatmaps and timers channel effort where it pays. - Lower Denial Rate Over Time: Root-cause fixes stick.
Monthly reviews turn one-offs into sustained improvement. - Less Burnout: Clear ownership, fewer fire drills.
Boards, templates, and alerts reduce cognitive load.
Minimal Tooling (Use What You Have)
- Kanban board: Trello, Asana, Monday, Jira, or your PM tool.
- Data & pivots: Excel/Google Sheets/BI (Power BI, Looker Studio).
- Templates & merges: Word/Google Docs with mail-merge or PM variables.
- Alerts: Native board automations, calendar reminders, or Slack/Teams bots.
Prefer a partner to own the legwork? We can run these RCM plays end-to-end—denial worklists, appeals, prevention edits, and deadline tracking—while your team stays focused on patient care.