AAFP members can ask a question at the Practice Management Help Desk.
Asia Blunt, MBA, CPC
Practice Management Strategist
This six-minute presentation quickly helps you learn how to calculate your practice’s denial rate. After watching this presentation, you will know how to:
The denial rate represents the percentage of claims denied by payers during a given period. This metric quantifies the effectiveness of your revenue cycle management processes. A low denial rate indicates cash flow is healthy, and fewer staff members are needed to maintain that cash flow.
Best Practice Tips
To calculate your practice’s denial rate, add the total dollar amount of claims denied by payers within a given period and divide by the total dollar amount of claims submitted within the given period.
Failure to identify mistakes prior to claim submission. Mistakes made during coding and charge entry can result in claims that are adjudicated and rejected by a payer. Establishing an internal process to identify and correct any mistakes prior to claim submission will decrease denial rates and produce a healthier cash flow.
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