Where your denials are actually made
Almost no denial is created by the department that reports it. This is a front-to-back review of the twenty steps between booking a patient and banking the money, ending in a written answer to one question: which step is producing this, and what has to change there. Free before you pay anything.
The problem with a billing report
A practice that is losing money to denials usually has plenty of reports. What it does not have is a sentence naming the step where the loss begins, and that is a different piece of work. A denial coded as a registration error arrives in billing. A charge that was never raised produces no denial at all. An underpayment posts as a closed account. Each of those is invisible from the place it gets noticed.
So the assessment walks the whole cycle in the order money actually moves, and reads real accounts rather than summaries. The output is a short list of root causes ranked by what each one costs, not a survey of everything that could be improved. A root cause is only worth the name if you can say which step it lives at and who would have to do something different.
The twenty steps, and what goes wrong at each
Before the visit
Registration · Insurance verification · Eligibility · Authorisation and referral · Scheduling
Most preventable denials are made here and discovered ninety days later. A member ID typed from a photograph of a card, a secondary plan nobody asked about, an authorisation obtained for the wrong site of service. The front desk has thirty seconds and a waiting room; the denial arrives in a different department, months later, and is filed as a billing problem.
The visit
Documentation · Charge capture · Charge entry · Diagnosis selection · Modifiers
A charge that is never created produces no claim, no denial and no report. It is the only revenue failure that is completely invisible from the billing side, because there is nothing to chase. The way to find it is to count encounters closed against charges raised, every day, and look at the difference.
The claim
Claim creation · Scrubbing · Submission · Rejections · Corrected claims
A rejection is not a denial. It never reached adjudication, so there is nothing to appeal and no clock running in your favour. Practices routinely work denials carefully and let rejections sit in a clearinghouse queue nobody owns.
The money
ERA and EOB processing · Payment posting · Contractual adjustments · Refunds · Credit balances
Underpayments post silently. If an adjustment is taken to close a balance rather than because the contract says so, the account balances to zero and the shortfall becomes invisible. This is the failure that never appears in an ageing report, because the account is closed.
What is left
Denial management · AR follow-up · Appeals · Patient balances · Write-offs
Follow-up is the job that nothing in the building complains about when it is skipped. No patient rings, no clinician notices, no report turns red. It simply ages past the filing limit, at which point the money is gone and the write-off looks like a decision.
Who is accountable when a step fails
A handover with nobody on either side of it costs more than a missing skill, and it is harder to see. The front desk believes billing will catch a bad member ID, billing believes the front desk verified it, and the denial that follows belongs to neither. Both are working hard and both are right about their own job.
So every procedure the assessment produces answers the same five questions in order: who does this step, when in the day they do it, what they verify before moving on, what happens next, and who owns it when it turns out to be wrong. Accountability written like that survives a staff change. A process that lives in one experienced person’s head leaves the building with them, and that is usually the real reason a practice is looking for help at all.
What you get back
One document, written for the person who has to act on it rather than for a file.
- What the accounts show now, with the numbers reproduced so you can check them.
- The causes we could evidence, ranked by what each is costing, and the ones we could not evidence said plainly rather than padded into the list.
- What to change at each step, and who has to do it.
- The quality control that would have caught it: what to check daily, weekly and monthly, and at which point in the day it has to happen to still be useful.
- Written procedures for the steps that need one — the things most practices call SOPs — against your systems and your payers, naming the person responsible at each handover. An SOP that does not name a person is a description, not a control.
- Training material for your existing staff: the checklist, the common errors, and what to do when something does not fit the process.
What is deliberately absent is a benchmark to judge you against. We do not hold a sourced figure for a good days-in-AR number and will not repeat one.
Then either your team runs it, or we do
The assessment is deliberately separate from what follows, because most of what it finds is fixable by the people already there once somebody has written down what good looks like. Where a queue genuinely needs a full-time person, a seat is one trained person on your account, forty hours a week, on United States hours, inside your own system through a login you issue. The price is published: $1,500 to $2,500 a month depending on the role, one month minimum, thirty days notice, no percentage of collections and no setup fee.
Questions
What do you look at in the first two weeks?
Three counts, before any opinion. Encounters closed against charges raised for the same period, which finds missing charges. Denials grouped by the step that caused them rather than by code, which usually moves half of them out of billing and into registration. And the age of the oldest unworked claim in each queue, which tells you what is already unrecoverable. Everything after that is reading the actual accounts.
Which KPIs do you report against?
Six, and no more, because a KPI nobody looks at weekly is a report. Days in AR, the share of AR over ninety days, net collection rate, first-pass acceptance, denial rate by cause, and the share of denials that are appealed at all. The last one is the least quoted and the most revealing: a practice appealing a small fraction of its denials has decided, without deciding, that most denied money is not worth chasing.
Do you publish a benchmark to compare us against?
No. We hold no sourced figure for a good days-in-AR number, and repeating one everybody repeats would be inventing a standard to judge you against. The comparison that means something is your own figure last quarter, and the share of AR over ninety days, which is where filing limits and appeal windows actually run out.
Are the procedures written for us, or a template?
Written against what your staff actually do, which is why the assessment comes first. A procedure that describes an idealised practice gets read once. The useful version names your systems, your payers and the person who does each step, and says what to do when the step fails rather than only when it works.
Will you train our existing staff or replace them?
Either, and they are different engagements. Training leaves the work with your team and gives them a written process and a checkpoint that catches errors before submission. A seat takes a queue off them entirely, full time, on United States hours, inside your own system. Most practices that ask for one end up wanting some of both, and the assessment is what tells you which queues are worth which.
What does the assessment cost?
Nothing, before you have decided anything. Send an aged AR report and a denial export and you get back what we found, in writing, whether or not you go further. Seats are $1,500 to $2,500 a month each, one month minimum, thirty days notice, no percentage of collections and no setup fee.
Do you work in our system?
Inside your own tenant, through a login you issue and can revoke. We are not a partner or a reseller of any vendor and hold no product certification in any of them. A biller is trained on the workflow rather than on one vendor’s menus, which is what makes the answer the same across systems.
Start with the part that costs nothing
Send an aged AR report and a denial export. You get back what we found and which step is producing it, in writing, before you have decided anything.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to ops@softhomeglobal.com and skip the form entirely. What happens to it.
The parts of the cycle, in detail
Next step
A denial you can trace is a denial you can stop
Send an aged AR report and see what we find before you pay anything.
Or write to ops@softhomeglobal.com