Are Primary Care Claim Denials Increasing Revenue Loss?

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Yes,  primary care claim denials are increasingly contributing to revenue loss for physician practices by delaying reimbursements, increasing administrative workload, and weakening overall revenue integrity. As payer scrutiny intensifies and documentation requirements expand, primary care practices across the country are seeing a measurable rise in denial rates that directly affect operational stability and financial outcomes. Primary care providers operate on high patient volumes and relatively thin margins. When denials increase—even slightly—the cumulative impact can significantly reduce collections and ultimately affect a practice’s ability to yield EBITDA . Understanding why these denials occur and how to prevent them is essential for maintaining a healthy revenue cycle. The Growing Impact of Primary Care Claim Denials In recent years, payers have strengthened claim review processes, automated adjudication systems, and documentation requirements. These changes have led to...
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Improving Ambulatory Surgical Center (ASC) Collections

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Improving Ambulatory Surgical Center (ASC) Collections

With patients having more financial responsibility for their healthcare, outpatient settings like ambulatory surgery centers are becoming more attractive to patients. A research report from Bain & Co. estimates that the number of procedures taking place in outpatient surgery centers will rise from 23 million in 2018 to 27 million in 2021. As per the same report, out of all outpatient surgeries done in the year 2017, half were performed by ASCs. Now as things are settling down after the corona pandemic, these numbers are again looking realistic. Before getting prepared for this growth potential, you have to streamline your current ASC billing process. In this blog, we discussed Ambulatory Surgical Center (ASC) billing challenges and ways to counter them. We are confident that these tips will help in improving your Ambulatory Surgical Center (ASC) collections. 

Tips for Ambulatory Surgical Center to Improve the Patient Collections Process

Always Take Prior-Authorization

Prior to the date of surgery, always verify eligibility and benefits to understand coverage and determine the party responsible for payment. Always call the insurance company and as per your discussion with the insurance representative, if required, obtain prior authorization. Obtain pre-determination if prior authorization is not required. An insurance company may not process the pre-determination request, try to take approval for pre-determination based on medical necessity. In absence of prior authorization, an insurance company may not pay for offered services. Prior authorization is such a key element of ASC billing that you should have a dedicated team for doing eligibility verification and prior authorization.  

If you want to read the complete blog then click below:  Improving Ambulatory Surgical Center (ASC) Collections


Location: California, USA

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