Synopsis
Denied claims represent one of the most significant threats to a healthcare provider’s financial performance. With rising administrative complexities and changing payer rules, it’s common for organizations to leave millions of dollars uncollected each year simply because denials aren't properly worked or appealed. The good news? Most denials are preventable.
At Orgusta, we specialize in denial recovery and prevention. Our trained denial management team takes a strategic, analytical approach—working denials by category, reason code, and payer-specific rules to maximize successful appeals. But we don’t stop there. We dig deeper to identify root causes and implement preventive strategies that reduce future denials and enhance clean claim rates.
Best Practices for Maximizing Revenue Recovery
✅ Specialize by Payer – Assign experts familiar with specific payer rules to speed up appeals.
✅ Maintain Payer-Specific Appeal Libraries – Streamline responses with pre-approved templates.
✅ Leverage Denial Trends – Optimize registration, coding, and billing based on reason code data.
✅ 48-Hour Appeal Turnaround – Submit appeals quickly to avoid missed deadlines.
✅ Integrate Analytics with Training – Use denial insights to educate staff and prevent future losses.
✅ Conduct root cause review of top 10 denial types quarterly and track progress
✅ Perform monthly denial audits by payer and service type
Expected Results with Orgusta
💰 Recover 15–25% of denied revenue through strategic appeals.
📈 Increase first-pass resolution by 10–15% with cleaner claims.
⬇ Reduce denial volumes by 20–30% through proactive prevention.
⏱ Lower write-offs & speed up reimbursements with efficient workflows.
📈 Accelerate reimbursements through standardized appeal templates, tracking tools, and escalation matrices
Stronger payer relationships through consistent, accurate, and professional engagement
Why Orgusta?
Unlike many firms that only focus on the recovery piece, Orgusta delivers a dual impact—speedy appeal resolutions and long-term denial prevention. Our process ensures that every denial is not just fixed, but also understood and prevented. We empower your teams, improve your claim integrity, and protect your revenue at every step.