Why 89% of Denials Are Totally Preventable—But Most Practices Don’t Know How

When medical practices face claim denials, the initial instinct is often to accept them as part of the healthcare billing process—just another frustrating cost of doing business. But that perception is wrong. In reality, the overwhelming majority of denials aren’t just frustrating—they’re avoidable. According to data from the Medical Group Management Association (MGMA), as many as 89% of claim denials are potentially preventable with proper processes and oversight in place. That means the majority of lost revenue tied to denied claims could be recovered—if practices knew where to look and how to act.

At Access1, we work with healthcare providers every day who are unaware of just how much revenue is slipping through the cracks due to repeatable errors in their billing process. Denials are often treated as isolated problems, but they are usually symptoms of deeper, system-wide inefficiencies that, once identified, can be corrected with the right strategy.

Preventable Denials: What’s Really Going Wrong?

The high rate of preventable denials stems from a few key issues that show up again and again across nearly every type of medical practice. These include incomplete or inaccurate patient data, eligibility verification failures, missing documentation, outdated coding, and even submitting duplicate claims by mistake. These are not complicated errors—many are administrative and occur before the patient is even seen.

According to an analysis by the Change Healthcare 2020 Denials Index (source), the top three root causes for denials are:

• Missing or invalid claim data (approximately 27%)
  

• Authorization or precertification issues (around 18%)
  

• Eligibility problems (roughly 15%)
  

In other words, the vast majority of denials are caused by basic front-end process failures that can be corrected with better training, technology, and monitoring.

The Financial Impact You Might Not See—Yet

Claim denials don’t just delay revenue—they threaten it entirely. The average cost to rework a denied claim is estimated at $25 per claim, and that figure can climb significantly if manual follow-up is required. Even more alarming, up to 35% of denied claims are never resubmitted, according to a Healthcare Financial Management Association (HFMA) report (source). That’s money permanently left on the table.

For a small or mid-sized practice submitting hundreds or thousands of claims each month, these cumulative losses can translate to tens—or even hundreds—of thousands of dollars annually. Worse yet, persistent denial issues can result in long delays in reimbursement, stress for your staff, and poor patient satisfaction when billing issues arise.

Technology Alone Won’t Solve It

Many practices assume that their billing software or electronic medical record (EMR) system is “handling” the claims properly. But software only works as well as the people and processes behind it. Denial prevention requires active engagement from both front-office staff and back-end billing teams. It’s a full-cycle process—not a set-it-and-forget-it solution.

For example, real-time eligibility checks should be performed before every patient visit. Authorization requirements should be verified by staff trained to understand payer nuances. Claims should be scrubbed thoroughly for accuracy, and denials must be tracked by reason code to spot recurring issues. When these steps are overlooked—or unevenly applied—denials creep in and revenue slips away.

What Your Practice Can Do Right Now

The good news is that denial prevention doesn’t require a complete overhaul. It starts with a few key steps:

1. Conduct a Denial Audit
   Begin by reviewing your top 10 denial codes. Understanding the most common reasons claims are being rejected in your system will point you directly toward the root causes.
   

2. Train Front-Office Staff
   The majority of denials originate before the provider ever sees the patient. Ensuring that front-desk teams are properly trained on data entry, eligibility checks, and insurance verification can drastically reduce errors.
   

3. Use Analytics to Track Trends
   If you're not already using denial management dashboards or analytics, now is the time. Data can help highlight bottlenecks, identify payers causing the most issues, and track the effectiveness of your improvements over time.
   

4. Consider a Billing Partner
   Outsourcing denial management and RCM services to a specialized partner like Access1 ensures that every claim is followed up on, trends are tracked in real-time, and industry best practices are built into your daily workflows.
   

Preventable Doesn’t Mean Inevitable—Act Now

Denials are not a cost of doing business. They are signals—warning signs—that your systems and processes need adjustment. The best-performing practices are not the ones with the fewest denials, but the ones that act on them quickly and intelligently.

Access1, based in Colorado, proudly supports healthcare providers across the U.S. with expert denial management and RCM services. While headquartered in Colorado, Access1 works with medical practices from Denver to Dallas, and from Phoenix to Philadelphia—delivering scalable solutions that eliminate revenue leakage and support long-term financial health.

We’ve helped practices cut their denial rates by as much as 40% in under six months, simply by implementing better workflows, denial tracking, and training. We know that revenue cycle management can feel like a black box—but it doesn’t have to be.

Are denials costing your practice more than you realize? Let’s find out together.

👉 Schedule a free denial audit with Access1 today and start reclaiming lost revenue.