Struggling with Denied Claims? Here’s What Might Be Going Wrong — and How to Fix It

Denied insurance claims can be more than just an administrative hassle — they disrupt revenue flow, strain resources, and impact the overall efficiency of healthcare organizations. At MHBS RCM, we understand how costly and frustrating claim denials can be. That’s why we’re here to help you uncover the most common causes of denials and guide you toward smarter revenue cycle practices.

Let’s break it down.

🔍 Why Are Your Claims Being Denied?

Understanding the root causes of denials is the first step to reducing them. Here are the key culprits we often identify when auditing denied claims:

1. Inaccurate or Incomplete Patient Information

Even small errors in names, insurance IDs, or demographic details can trigger an automatic denial. Accurate data entry at the front desk can save hours on the backend.

2. Missing Documentation or Lack of Medical Necessity

Insurers require clear evidence that services provided are medically necessary. Missing, incomplete, or vague documentation can lead to a denial — even if care was appropriate.

3. Outdated or Incorrect Coding

One wrong CPT or ICD-10 code can lead to a claim rejection. Staying updated with the latest coding guidelines and ensuring internal audits are in place is critical.

4. Eligibility Not Verified

Submitting a claim without confirming the patient’s current insurance coverage often results in a denial. Real-time eligibility checks are essential before every appointment.

5. Timely Filing Delays

Each payer has a set timeframe for submitting claims. Missing those deadlines, even by a day, can cost your practice revenue.

💡 What Can You Do?

Reducing denials requires a combination of proactive processes, skilled professionals, and the right technology. That’s where MHBS RCM makes a difference.

We help healthcare providers by offering:

✔️ Comprehensive denial management

✔️ Real-time eligibility verification

✔️ Expert medical coding and auditing

✔️ Advanced claim scrubbing before submission

✔️ End-to-end revenue cycle solutions

Our goal? Fewer denials. Faster payments. Smarter billing.

📌 Takeaway for Healthcare Providers

Don’t let denied claims slow down your revenue cycle. With the right RCM partner, most of these denials can be avoided or resolved quickly. At MHBS RCM, we empower your practice to operate efficiently and get paid accurately — the first time.

🔗 Learn more about how MHBS RCM can support your billing needs: www.mhbsrcm.com