How do I lower my practice's denial rate?
You lower a denial rate by fixing the few front-end causes that drive most denials — eligibility, prior auth, and coding — and by working every denial to root cause instead of rebilling blindly. A healthy first-pass rate is above 90%; most independent practices sit in the 75–85% range and don't realize how much they're leaving behind.
What actually matters
- Verify eligibility and benefits before every visit — stale or wrong coverage is the single largest denial source
- Track prior authorizations as a workflow with a due-date and a confirmation number tied to the claim, not a sticky note
- Scrub claims for the top payer edits (modifier 25, NCCI bundling, medical-necessity dx) before they go out
- Categorize denials by reason code monthly — you can't fix what you don't measure, and a handful of CARCs usually drive most of the volume
- Work denials to the real cause and appeal the winnable ones; a corrected-and-rebilled claim without fixing the cause just denies again
Common questions
What is a good denial rate for a medical practice?
Under 5–10% initial denial rate, with a first-pass resolution rate above 90%, is considered healthy. Many independent practices run 15–20% and write off a large share unworked.
What causes the most claim denials?
Front-end issues dominate: eligibility and registration errors, missing prior authorization, and coding or documentation gaps. These are preventable, which is why they're the highest-leverage place to start.
Where Volari fits: Volari works the denials you've already written off — the pile that never gets appealed because chasing each one by hand costs more than the claim returns.
See the revenue you're owed but never collected.
A free assessment shows your real recoverable number from denied and underpaid claims. No risk, paid only on what we recover.