Back of cycle
Denials worked to root cause, not just resubmitted
Every denied claim categorized, appealed where appropriate, and fed back upstream so the same failure does not repeat next month. Most appealed denials are ultimately paid. The money is lost because nobody pursues them.
The denials are not the problem. The abandonment is.
Here is the part most practices do not realize: appealed denials usually win. Payers overturned 67% of appealed Medicare Advantage prior authorization denials in 2025 (KFF, 2026). Hospitals recovered roughly 70% of the denials they pursued (Premier Inc., 2025). In ACA marketplace plans, around a third of appealed claim denials were overturned — but fewer than 1% of denials were ever appealed at all (KFF, 2025).
The reason is not that practices do not care. It is that appeals are labour-intensive and the staff are already stretched. Among physicians, 59% say they do not appeal because they expect the appeal to fail, and 52% cite insufficient staff time (AMA, 2026). Both of those are solvable with capacity and process.
Nationally, final denials and bad debt cost providers $48.4 billion in 2025, up about 25% in a single year (Kodiak Solutions, 2026). A meaningful share of that was recoverable and simply never pursued.
- Every denial categorized by CARC/RARC and root cause, not just logged
- Appeals written, submitted and tracked to decision
- Aged and legacy A/R worked, including claims inherited from a prior partner
- Timely filing and appeal deadlines tracked per payer
- Recurring denial patterns traced back to the front end and fixed there
- Payer behaviour documented so the same fight is not re-learned each time
- No write-off without your explicit approval
How it works
What we actually do
Denials are categorized, not just counted
A denial report that says ‘47 denials this month’ is useless. Ours says which payer, which reason code, which provider, which service line, and whether it is preventable.
Appeals are written by people who know the payer
An appeal that restates the claim gets denied again. An appeal that addresses the specific reason code, cites the policy and attaches the right documentation gets paid.
Aged A/R gets worked, including what you inherited
Legacy A/R is often the fastest money in an engagement, because those claims were already earned and simply stalled. We agree the approach to aged claims before transition begins.
Root causes go back upstream
If eligibility errors are generating denials, the fix belongs at the front desk, not in the appeals queue. A denial worked once is revenue; a denial pattern fixed is revenue every month.
You see the denial picture, not a summary
A/R aging by payer and denial reason, available any day of the month rather than at month end.
Common questions
What practices ask us about this
Will you work denials from before we hired you?
Yes. Aged and inherited A/R is part of the engagement and is usually where the first meaningful recovery comes from. We agree the cut-off and approach during onboarding.
What is your appeal success rate?
This should be answered with UnifiedRCM’s own verified figures before launch. For context, provider appeal success across a large 2025 dataset ran near 42% (Kodiak Solutions), while hospital-side recovery on pursued denials ran near 70% (Premier Inc.). Any vendor quoting a number far outside that range without a methodology is worth questioning.
Do you appeal small-dollar denials?
Yes. No dollar floor. A $38 denial repeated 400 times a year is $15,200, and it is exactly the kind of loss that never appears in anyone's summary report.
How do you stop the same denials recurring?
By treating root cause as the deliverable. Each recurring pattern is traced to its origin — registration, eligibility, coding, documentation or authorization — and the fix is implemented where the failure starts.
Who decides when a claim gets written off?
You do. We recommend; you approve. Write-offs are not a decision we make on your behalf.
Related services
The rest of the cycle
Find out what your revenue cycle is actually leaving behind.
Request a consultation and a revenue cycle specialist will walk through your denial patterns, A/R aging and payer mix with you. No obligation, and no software to install.