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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COVID Pathology, Now on the Down Turn… Who will Clean up Your AR?

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Exponential Growth of Pathology Services during COVID-19 

COVID-19 is caused by severe acute respiratory syndrome corona virus-2 (SARS CoV-2), a highly contagious single-stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. The treatment for COVID-19 was principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. Digital pathology was also introduced and the COVID-19 pandemic accelerated its adoption as there is the need to deal with higher (as much as 250 percent increase) case volume. During the COVID-19 pandemic, pathology billing witnessed high denied claims and staggering account receivables (AR). Our AR Cleanup & Insurance Follow-up Specialist Clean up your AR services to reduce medical practice costs & recover overdue payments from insurance carriers.

Pathology Billing During Pandemic

Even though the need for pathology services has increased exponentially, patient and insurance collection hasn’t increased to that extent. Billing and collecting for pathology and laboratory services is ‘tough’ and things got tougher during a pandemic. During the COVID-19 pandemic, most of the claims were denied by insurance carriers due to the absence of correct procedure codes, non-payable diagnosis codes, and incomplete documentation failing to prove medical necessity. Pathologists struggled to collect insurance reimbursement both as in-network and as out-of-network for various payers. 


To get more information about COVID Pathology click here: https://bit.ly/3I9uREg. Get in touch with us at: info@medicalbillersandcoders.com/ 888-357-3226. 
Location: United States

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