5 Proven Strategies to Reduce Medical Billing Denials Before Submission

Billing denials are more than just a hassle — they’re a silent revenue killer. For many providers, denial management happens after the damage is done. But what if you could prevent most of them before they even leave your office?

According to the American Medical Association (AMA), denial rates average between 5%–10% across U.S. healthcare organizations. For hospitals submitting thousands of claims per month, that’s hundreds of thousands of dollars left on the table.

The good news? Up to 90% of denials are preventable. And that’s exactly what we help providers do every day at Advanced Healthcare Revenue.

Here are 5 proven, field-tested strategies your organization can implement before submission to reduce denials and protect your revenue.

1. Verify Eligibility Every Time — Not Just for New Patients

It might sound basic, but eligibility and benefits verification is one of the most overlooked steps in the revenue cycle — and a top cause of denials.

Stat check: A Change Healthcare report found that 25% of claim denials are tied to eligibility issues, such as inactive policies or coverage mismatches.

Solution: Automate real-time eligibility checks at each visit (not just the first one). Patients change jobs, lose coverage, or switch plans more often than you think. If your front desk skips this step, your billing team pays the price later.

2. Use Front-End Edits and Claim Scrubbing Software

A clean claim is more than accurate — it’s denial-resistant. Software tools that "scrub" claims before submission catch missing data, code mismatches, and NPI issues before payers do.

Stat check: According to the Healthcare Financial Management Association (HFMA), organizations using front-end edits reduce denials by up to 30%.

Solution: Implement intelligent claim editing tools that flag errors like duplicate modifiers, invalid procedure-to-diagnosis pairings, or missing rendering provider details. It’s not just about compliance — it’s about keeping your AR clean.

3. Standardize Documentation Practices With Clinicians

Incomplete or inconsistent documentation is a major pain point — especially in specialties like behavioral health, pain management, and internal medicine.

Human moment: One of our clients — a small primary care group — was losing $12,000/month due to vague clinical documentation that didn’t support billed services. Once we provided clinician training and templates, denial volume dropped by 40% in 60 days.

Solution: Build provider cheat sheets, use structured templates in the EHR, and regularly audit notes. Keep it collaborative — not punitive. When doctors understand the financial impact of their notes, they become allies in your billing success.

4. Get Credentialing Right the First Time

Believe it or not, many denials trace back to a provider not being properly credentialed or enrolled with the payer. Even minor mistakes like a wrong TIN, NPI mismatch, or outdated CAQH profile can trigger months of delayed reimbursement.

Stat check: MGMA reports that credentialing issues cause up to 35% of payer-related denials, particularly with new or expanding practices.

Solution: Treat credentialing as a strategic priority — not an afterthought. Maintain up-to-date provider profiles, verify payer participation status regularly, and audit enrollments at least quarterly. Consider outsourcing this process to RCM experts (like us) to stay ahead of deadlines and avoid errors that cost you real money.

5. Train Staff on Payer Rules and Coding Updates

Even the best tools won’t save a team that isn’t trained. Frequent payer policy changes, annual CPT/ICD updates, and unique billing rules (especially for Medicaid or managed care plans) can cause clean claims to be rejected unnecessarily.

Human moment: One of our AHR clients faced a spike in denials for common preventive visits simply because their biller missed a payer update that bundled services differently. With monthly policy update training, their denial rate dropped by 22% in 3 months.

Solution: Schedule regular billing and coding workshops. Make payer updates part of your workflow. When everyone understands the rules, fewer mistakes slip through — and fewer dollars are lost in limbo.

Final Thoughts: Denials Don’t Have to Be Inevitable

Revenue loss from claim denials isn’t just a billing problem — it’s a system problem. But the good news is: it’s fixable. With proactive steps, cross-team training, and smart technology, most practices can slash their denial rates significantly.

Claim denials are not just administrative hiccups — they’re lost opportunities, delayed care, and unpaid time. For healthcare organizations already stretched thin by staffing shortages and shifting payer rules, the cost of preventable denials adds up fast.

Let’s break it down:

• Every denied claim costs an average of $25 to $118 to rework, according to the American Academy of Family Physicians (AAFP).

• Roughly 65% of denied claims are never resubmitted — meaning that once denied, that revenue is often gone for good.

• And denial rates are rising, with an 11% year-over-year increase, per the Change Healthcare 2023 Denials Index.

If you’re waiting until claims are rejected to take action, you’re playing defense. But high-performing practices are doing the opposite — they’re building preventive systems, training teams, and leveraging expertise to get claims right the first time.

At Advanced Healthcare Revenue, we help providers eliminate these costly missteps through our tailored revenue cycle audits, billing optimization, credentialing services, and denial prevention strategies. Our clients don’t just recover revenue — they build billing systems that support growth, compliance, and long-term financial health.

Don’t wait for your next denial to take action.

Let us take a deep look into your process — no cost, no strings attached.

📍 Book your FREE Revenue Cycle Audit today at www.ahrevenue.com or call 415.857.2854.