Every denied claim represents more than just delayed reimbursement — it’s money that providers may never recover. For many practices, denied claims pile up quietly in the background, creating cash flow problems, wasted staff time, and unnecessary frustration.
On average, claim denial rates in the U.S. hover between 5–10% depending on specialty and payer. At first glance, this may not sound alarming. But for a mid-size practice processing thousands of claims each month, even a 5% denial rate can translate into hundreds of thousands of dollars in lost revenue each year.
At Karepoint, we believe this level of financial leakage is unacceptable. That’s why our systems are designed to achieve a 95%+ claim approval rate — consistently. Yet, many billing companies still settle for lower performance. Let’s explore why high approval rates should be the standard, why most billing companies fall short, and how Karepoint changes the equation.
The Real Cost of Claim Denials
Denied claims carry hidden costs that extend far beyond the lost payment:
Rework Costs: Industry studies (MGMA/HFMA) show that each denied claim costs between $25 and $118 to rework. For practices processing hundreds of denials a month, these costs add up quickly.
Time Delays: It can take weeks or even months to resolve a denial, leading to unpredictable cash flow.
Lost Revenue: Roughly 65% of denied claims are never resubmitted. That means practices permanently lose money they’ve rightfully earned.
Patient Satisfaction Impact: Billing disputes and surprise balances can frustrate patients, straining the provider-patient relationship.
In short, denials don’t just reduce revenue — they drain staff time, inflate operational costs, and hurt practice reputation.
Why Most Billing Companies Settle for Lower Approval Rates
So why do so many billing companies accept denial rates of 5–10% as “normal”? The answer lies in gaps across the revenue cycle:
Inconsistent Eligibility Verification
Many billing companies skip thorough eligibility checks, leading to claims submitted for ineligible patients or non-covered services.
Missed Prior Authorizations
Procedures performed without prior authorization are one of the most common causes of denials.
Incomplete or Inaccurate Coding
Coding errors, under-coding, or missed HCC/CPC codes result in lost reimbursement or compliance risks.
Poor Documentation Practices
Missing provider notes, incorrect modifiers, or incomplete patient details lead to preventable rejections.
Weak Denial Management
Some companies treat denials reactively, simply resubmitting claims without addressing the root cause — ensuring the same issues repeat month after month.
These shortcomings explain why many providers think denials are just “part of the business.” But in reality, most are preventable with the right systems.
The Karepoint Difference: How We Consistently Achieve 95% Approval
At Karepoint, we don’t accept industry averages as the benchmark. Our processes are built to prevent denials upfront and resolve them quickly when they do occur. Here’s how we do it:
Eligibility Verification
Every patient is verified for active coverage, benefits, and deductibles before their appointment.
This prevents wasted time on ineligible claims.
Prior Authorization Management
We manage the entire authorization process, ensuring approvals are in place before services are delivered.
This eliminates one of the biggest causes of payer denials.
Certified Coding Expertise
Our CPC and HCC coders ensure accurate, compliant coding on every claim.
Regular audits catch under-coding or compliance risks before submission.
Proactive Denial Prevention
We analyze payer trends and denial patterns, implementing corrective measures to stop repeat issues.
Weekly reports keep providers informed about performance and payer behavior.
AR Follow-Up and Education
Our specialists chase outstanding claims aggressively while also educating providers on documentation best practices.
This dual approach prevents denials and ensures faster reimbursement.
By combining these strategies, we’ve consistently helped practices achieve — and maintain — claim approval rates above 95%.
Why 95% Should Be the Industry Standard
Here’s why we believe 95% claim approval should be non-negotiable for any medical billing partner:
Predictable Cash Flow: Practices can plan confidently without constant revenue interruptions.
Lower Administrative Costs: Fewer denials mean less staff time spent on rework.
Higher Provider Satisfaction: Physicians focus on patient care, not billing headaches.
Improved Patient Relationships: Transparent billing processes reduce disputes and surprise bills.
Sustainable Growth: Practices retain more of the revenue they’ve already earned, fueling expansion and reinvestment.
Yet many billing companies don’t prioritize these outcomes because achieving 95%+ requires specialized expertise, proactive systems, and continuous monitoring.
The Bottom Line
Denials don’t have to be an accepted cost of doing business. With the right approach, providers can prevent most denials before they happen and recover the rest quickly. At Karepoint, we’ve proven that 95%+ claim approval rates are not just possible — they should be the standard.
Our clients trust us because we go beyond transaction-based billing. We act as a strategic partner, helping providers secure every dollar they’ve earned while educating them on payer trends and compliance best practices.
If your current billing partner is telling you that high denial rates are “normal,” it may be time to ask whether they’re really protecting your revenue.
Ready to experience the Karepoint difference?
Book a consultation today to see how we can help your practice achieve 95%+ claim approval rates.