Denials and A/R
Denial management staff who work your denials and aged A/R
Denial management staff from OffshoreMeds appeal and resubmit denied claims, follow up on A/R within 48 hours and trace denials to their root cause, working in your practice management system. MGMA Stat reports first-submission denials of 7-8% over the past four years, and AAFP calls a rate below 5% more desirable than the 5-10% industry average. One flat monthly fee per seat, never a percentage of collections.
Published by OffshoreMeds. Facts last checked October 9, 2026. How we check our numbers.
The work
What denial management staff do
- Denial appeals and resubmission: correct the claim or build the appeal, then send it back to the payer.
- A/R follow-up within 48 hours: chase unpaid claims before they age.
- Root-cause denial analytics: group denials by reason, payer and provider so the cause gets fixed, not just the claim.
- Payer follow-up and escalation when a claim stalls.
- Eligibility and benefits checks before visits, so fewer claims are denied for coverage reasons.
Benchmarks
Denial rate benchmarks to measure against
| Measure | Rate | Source |
|---|---|---|
| Measure: First-submission denials across practices, past four years | Rate: 7-8% | Source: MGMA Stat, July 2026 |
| Measure: Industry average denial rate | Rate: 5-10% | Source: AAFP, Practice finances |
| Measure: More desirable denial rate | Rate: <5% | Source: AAFP, Practice finances |
Our denial teams aim for a denial rate under 5%. Whether a practice gets there depends on its payer mix, specialty and front-end process, so we start by measuring your current rate and its causes.
For what happens after a denial, KFF’s analysis of 2024 HealthCare.gov data found that insurers denied 19% of in-network claims, consumers appealed fewer than 1% of denied claims, and insurers upheld 66% of the appeals filed. That is the share of claims insurers denied, a different measure from the practice first-submission rates above, and it covers Marketplace plans only, so use your own payer and appeal data where you have it.
Scope
What denial management cannot promise
No one can promise that a payer will approve or pay a claim; the payer decides. Our staff work to make each claim, appeal and follow-up complete and on time, and daily production reporting shows you what was done.
Some denials start earlier in the cycle. Root-cause work can point to coding, which offshore medical coding staff audit daily, or to a missing authorization, which prior authorization staff track before the visit.
A claim that misses a payer’s filing deadline can be denied as untimely, so follow-up work starts from the deadline: see timely filing limits for medical claims.
Cost
What a denial management seat costs
A denial and A/R seat costs $1,500 to $2,000 per month. Prices are indicative until your written quote confirms the exact fee. Compare it with an in-house hire on the offshore medical billing cost page, and check the HIPAA and payer rules for offshore staff first.
The terms behind each seat
One flat monthly fee per seat, never a percentage of collections. A Business Associate Agreement is signed before anyone touches protected health information. Clinical decisions stay with your US-licensed providers. See all OffshoreMeds services.
Related guides
- Offshore medical billing cost
Seat fee, US in-house cost and percentage-of-collections fees side by side, with the method shown.
- HIPAA compliant offshore medical billing
The Business Associate Agreement, the safeguards, and the payer and state rules that can rule offshore work out.
- Offshore medical coding staff
ICD-10, CPT and HCC coders working in your EHR, audited daily against a published accuracy standard.
- Prior authorization staff
Staff who prepare, submit and track prior authorizations, with the clinical line kept where it belongs.
- Insurance eligibility verification staff
Coverage, benefits, authorization and patient-cost checks done before the visit, not after the denial.
- Percentage-of-collections fees
How the fee works, what Medicare, Medicaid and the OIG say about paying a billing agent, and questions to ask before you sign.
- Timely filing limits for medical claims
The federal caps, examples from Cigna, Aetna, Texas Medicaid and Illinois Medicaid, and how to find and track the limit that applies.
- Prior authorization timeframes (CMS rule)
Which payers the CMS rule covers, the 72-hour and 7-day timeframes, what it excludes and the dates that matter.
- OHIP stale-dated claims and error reports
The Ministry's three-month rule, the reports after each submission, the monthly cut-off and how to work rejected claims.
- Medicare appeal levels and deadlines
The five appeal levels for original Medicare claims, the deadline and decision-maker at each, and the 2026 and 2027 dollar thresholds.
Get Started
Book a free 30-minute call.
Pick a time below. Have these ready: the roles you need, your specialty and your EHR. We’ll come back with a fixed seat quote, candidate profiles to interview and a go-live plan.
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