Practice service · every specialty

Medical billing, worked to the last denial.

Getting a claim out the door is the easy half. What separates a practice that collects from one that writes off is what happens to the one claim in ten that comes back — and whether anyone finds out why, in time to stop the next one.

See what my denials look like How the cycle runs

Coders read the chart firstYour NPI, your moneyRoot cause fed back monthly

How often professional claims are denied

Initial denial rate on professional claims, by payer type.

Medicaid managed care15.1%

Medicare Advantage10.5%

Commercial7.8%

Source: Health Affairs Scholar, 2026 — analysis of 234 million professional claims from 2019. Bars are scaled to the highest rate shown.

How it runs

One pass forward, one loop back

The loop is the part most practices never staff. It is also the only part that stops the same denial arriving again next month.

The claim, end to end

Every claim

Step 1Registration & eligibilityCoverage confirmed before the visit, not after the denial.

Step 2Coding & charge entryA coder reads the note, then assigns codes and modifiers. Nothing left unbilled.

Step 3ScrubbingPayer-specific edits run before the claim leaves the building.

Step 4SubmissionElectronic where the payer takes it, paper where it does not.

Step 5PostingPayments and adjustments posted, underpayments flagged.

BillingA/R & denialsEvery denial routed back to a coder with the payer reason attached.

A denial does not just get reworked. The reason code is grouped, counted and reported, so the fix lands upstream at registration or coding rather than being re-fought claim by claim.

The economics

Denials are not expensive. Unworked denials are.

Every figure below is somebody else’s published research. We would rather show you the industry than invent a track record.

What providers say is causing denials

Missing or inaccurate data50%

Authorization problems35%

Incomplete patient registration32%

Three of the top causes are clerical, not clinical — which means they are fixable by process rather than by appeal.

Source: Experian Health State of Claims, 2025 — survey of 250 billing decision-makers, multiple answers allowed.

What happens to a denied claim

Roughly two in five denials were never resubmitted at all. Of those that were, most were overturned — the money was there, and nobody went back for it.

Source: Health Affairs, 2025 — Medicare Advantage claims. 57% of all denials were ultimately overturned.

What working a denial costs

Published figures

To rework one denied claim

$25.20

Manual claim status check

$13.80

The same check, electronically

$3.64

Denials that were avoidable

~50%

Rework cost from MGMA (2021). Claim-status inquiry costs for medical providers from CAQH Index (2024). The avoidable share reflects the front-end causes above — registration, eligibility and authorization — rather than clinical or medical-necessity disputes. These are published industry figures, not OnPoint RCM results.

Division of labor

What we do, and what stays with you

OnPoint RCM does

Verifies eligibility and benefits before the visit
Codes from the note, not from a superbill guess
Runs payer-specific scrubbing before submission
Submits, posts and reconciles every remittance
Works A/R by age and by payer, not by whoever calls
Appeals with the clinical documentation attached
Reports denial root causes monthly, grouped and counted

Your practice keeps

The NPI on the claim — payments go to you
Final say on any code that changes
Your fee schedule and your contracts
Direct access to every report and work queue
The clinical record, in your EMR

Questions we get

Before you ask

Do you take custody of our money?

No. Claims go out under your NPI and payments land in your account. We never sit between you and the payer, and there is no arrangement in which our fee comes out of a deposit before you see it.

What happens to claims already sitting in old A/R?

We work them alongside current claims, oldest and largest first, and tell you honestly which ones are past timely filing and not worth the labor. Writing off what cannot be collected is part of the job.

Do you code, or just bill what we send?

We code. A coder reads the documentation before the claim is built. If the note does not support the level billed, you hear about it from us rather than from a payer audit two years later.

How will we know it is working?

A monthly file: first-pass acceptance, days in A/R, denials grouped by root cause, and what changed since last month. If a number moves the wrong way you will see it from us before you feel it in the bank.

A note on the numbersEverything cited on this page describes the industry, not OnPoint RCM client results. The denial rates come from peer-reviewed analyses of hundreds of millions of professional claims; the cause data comes from a provider survey; the cost figures come from MGMA and CAQH. Clean-claim-rate averages circulate widely online without a traceable primary source, so we do not quote one — HFMA MAP Keys publishes the definition, and we report yours against it monthly.

See what your practice is leaving on the table

A 30-minute call. Tell us roughly how many Medicare patients you see, which EMR you use and what you already run in-house. We come back with which programs your patients qualify for, what each one would take to run, and what it is likely to be worth.

Call (636) 634-1229

(636) 634-1229Mon–Fri, 8am–6pm CT

info@onpointrcm.comWe reply the same business day

201 Clarkson Executive ParkEllisville, MO 63011

Request a practice review

Same-day reply. Nothing is billed and no patient is enrolled from this form — it starts a conversation, nothing more.

[sureforms id=”9026″]