Claims Denials Management & A/R Recovery for Faster Cash Flow
Our Denials & A/R Recovery service is designed to restore financial health to your practice by reducing denials, resolving aged receivables, and maximizing revenue recovery. We bring a disciplined, data-driven approach to uncovering the root causes of payment delays and building sustainable systems that ensure claims are paid accurately and on time.
Root-Cause Denial Analysis (PA, Eligibility, Coding, TFL)
Every percentage point of denials represents real cash left behind. Our analysts segment every denial by type—eligibility, prior authorization, coding accuracy, and timely filing—to expose true root causes. We turn that data into payer-specific edits and pre-submission checks that stop errors before claims ever leave your system.
Standardized Appeals & Payer-Specific Playbooks
Different payers, different rules. We maintain a library of payer-specific appeal templates, attachments, and escalation paths so your staff never starts from zero. Appeals are tracked with turnaround SLAs and real-time dashboards showing status, recoveries, and overturn percentages.
Working Down Aged A/R with Precision Queues
Aged receivables require prioritization, not guesswork. We stratify your A/R by dollar value, payer, and denial reason, assigning claims through automated worklists that balance effort vs. yield. Each closed claim feeds back into denial prevention analytics to prevent recurrence.
KPIs We Move and How We Track Them
- Denial Rate: Target < 5 % across all payers
- First-Pass Yield: > 98 % clean-claim submission
- Days in A/R (DSO): Reduced by 5–10 days within one quarter
- Appeal Success Rate: Measured per payer, trended monthly
Interactive dashboards surface payer outliers and root-cause trends so leadership can act immediately.
Why PR360 for Denial Management and A/R Recovery
We combine analytics-driven insight, deep payer knowledge, and disciplined execution to convert denied revenue into cash—fast. Our clients typically see 15–30 % fewer denials and 20 % faster reimbursement within the first six months.
FAQs
Q.1 Which denial types do you address?
A1. We target coding and modifier errors, prior authorization, medical necessity, bundling, eligibility, timely filing, and documentation-related denials—plus payer-specific patterns revealed by analytics.
Q2. How quickly can results be seen?
A2. Leading indicators often improve within one to two billing cycles; sustained cash acceleration typically follows in 60–120 days as root-cause fixes take hold.
Q.3 Do you work legacy A/R backlogs?
A3. Absolutely. We prioritize by age, balance, and payer; implement focused worklists and appeal pathways; and set QA checks and recovery targets for aged buckets.
Q4. What KPIs do you track?
A4. Some of the KPIs we normally track include denial rate, first-pass clean-claim rate, DSO, net collection rate, zero-pay rate, and aged A/R distribution—reported by payer and reason code for actionable insight.
Q5. Do you train our team and update workflows?
A5. Yes. We deliver payer-specific edits, appeal templates, and workflow updates, and train staff to sustain improvements and prevent recurrence.