Medxcode medical billing and coding

Every denial is either recovered or explained

We work denials to resolution instead of to a write-off — with root-cause coding, payer-specific appeal packages and prevention rules that stop the repeat.

Get a free analysis (239) 748-0627
71%
Denial overturn rate
-41%
Repeat denials after 6 months
3 days
Average time to first appeal
$1.4M
Recovered last quarter
Medical billing specialist collaborating with a clinician

Talk to a denial management specialist

Send us your numbers. You get a written analysis of what is recoverable, within one business day.

HIPAA-aligned handling. We never share your details. No contracts to sign to talk to us.

Roughly two out of three denied claims are never reworked, and the average practice writes off between 2% and 5% of net patient revenue as a result. That money was already earned — the service was delivered, the documentation exists, the contract entitles you to payment.

Medxcode's denial management service treats a denial as an unfinished claim, not a lost one.

How our denial workflow runs

Denials are triaged daily by dollar value, payer, timely-filing runway and overturn probability. Nothing waits for a weekly meeting.

  • Daily ERA and correspondence review with automated denial capture
  • Categorization by CARC/RARC and internal root-cause code
  • Corrected claim, reconsideration or formal appeal — chosen per payer policy
  • Payer-specific appeal letters with clinical documentation attached
  • Peer-to-peer and medical-necessity escalation support
  • Timely-filing watchlist so no appeal window closes
  • Prevention rules pushed back into scrubbing and coding
  • Monthly denial scorecard by payer, provider and reason

Root cause beats rework

Rework recovers this month's money. Root cause protects next year's. Every denial we work is tagged with the operational failure that produced it — registration, eligibility, authorization, coding, documentation, contract or payer error — and the top three drivers become the following month's fix list.

Practices that follow this loop typically see repeat denial volume fall by a third or more within two quarters.

The denials we recover most often

Some denial categories look final and are not. These are among the most frequently overturned once documentation is assembled correctly:

  • CO-16 missing information — corrected and resubmitted within 48 hours
  • CO-197 authorization required — recovered with retro-auth requests where payer policy allows
  • CO-50 not medically necessary — overturned with clinical documentation and policy citation
  • CO-97 bundled service — overturned with correct modifier and NCCI argument
  • CO-45 charge exceeds fee schedule — reviewed for contract underpayment
  • CO-29 timely filing — appealed with proof of original timely submission

How it works

Onboarding that does not interrupt your clinic

  1. 01

    Denial inventory

    We pull every open denial and rejection, size the recoverable pool and rank it by value and deadline.

  2. 02

    Work the backlog

    High-value and near-deadline claims first, with appeals filed in payer-preferred format.

  3. 03

    Fix the source

    Root-cause reporting drives changes in registration, coding and scrubbing rules.

  4. 04

    Hold the line

    Ongoing daily denial management with a monthly scorecard and prevention review.

Packages

Denial Management packages built around volume, not lock-in

Managed service fees start at 3.99% of monthly collections. Specialized projects receive a written custom scope based on volume, complexity and the work required.

Recovery Project

Custom scope

proposal based on recoverable balance

One-time cleanup of a denial backlog

  • Full denial inventory and valuation
  • Backlog worked by value and deadline
  • Appeals filed to resolution
  • Root-cause summary report
  • No recovery, no fee
Most chosen

Managed Denials

Custom scope

proposal based on recoverable balance

Ongoing denial management alongside your billing

  • Daily denial triage and appeals
  • Payer-specific appeal library
  • Root-cause tagging and prevention rules
  • Timely-filing protection
  • Monthly denial scorecard and review call
  • Dedicated denial analyst

Denial Prevention

Custom scope

proposal based on scope

Groups targeting a sub-5% denial rate

  • Everything in Managed Denials
  • Payer contract and policy monitoring
  • Scrubber rule engineering
  • Provider and front-desk training
  • Quarterly denial trend forecasting
  • Executive denial dashboard

Calculator

See the numbers before you talk to us

Denial recovery calculator

Estimate what your current denial rate is costing you and what a managed denial workflow recovers.

1,800

Claims submitted each month.

$240

Average allowed amount per claim.

15%

Share of claims denied on first submission.

Projected annual denial recovery

$513,216

Annual recoverable value from a disciplined appeal and prevention program

Denied claims / month
270
Denied dollars / month
$64,800
Typically recoverable (66%)
$42,768

Estimates use benchmark recovery rates from comparable US practices. Your written analysis replaces these estimates with numbers from your own payer mix.

Want this modelled on your real data?

Send the form your figures and we will rebuild this estimate from your payer mix, fee schedule and current aging — free, in writing, with no obligation.

  • Written analysis within one business day
  • Line-item view of recoverable revenue
  • Root-cause list for your top denials
  • No contracts required to receive it
Try the full custom cost calculator →

Send me this analysis

We will use the figures you moved above as a starting point.

HIPAA-aligned handling. We never share your details. No contracts to sign to talk to us.

Proof

Denial Management results from real practices

+38%

Net collections in two quarters

14-provider cardiology group cuts days in A/R from 71 to 44

Cardiology · New York

-46%

Authorization denials

Behavioral health practice cuts authorization denials by 46%

Behavioral Health · Texas

$428K

Delayed revenue recovered

Gastroenterology group recovers $428K in delayed infusion revenue

Gastroenterology · California

FAQ

Denial Management questions we get every week

Do you work denials you did not cause?
Yes. Most engagements start with a backlog created before we arrived, including claims other billing companies wrote off.
How far back can denials be recovered?
It depends on payer timely-filing and appeal windows, which range from 90 days to 24 months. Our first step is mapping which claims still have a live runway.
What is your overturn rate?
Across our book of business, roughly 71% of appealed denials are overturned or partially paid. Rates vary by payer and denial category, and we report yours specifically.

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