Denials are not just an inconvenience—they are a billion-dollar problem for healthcare providers. Whether caused by medical necessity disputes, technical errors, or delayed appeals, each denied claim represents lost revenue and wasted resources. At ERN, we help healthcare organizations prevent, manage, and overturn denials through proactive strategies, ensuring faster reimbursements and financial stability.
spent trying to overturn denied claims in 2022.
of claims denials are recoverable.
of claim denials are recoverable.
Without a proven denial strategy, providers risk millions in unnecessary write-offs. ERN ensures your organization is equipped to prevent and recover denials to preserve cash flow and patient access to care.
With decades of experience in healthcare reimbursement advocacy, ERN offers a comprehensive approach that combines administrative expertise, technology, and proven strategies to reduce denials and recover revenue. We’re dedicated to partnering with you to ensure your appeals have impact and instill preventative measures prospectively, concurrently, and retrospectively.
Payors often deny claims based on medical necessity, even when treatment was essential, forcing providers to undergo complex appeals to justify care. These denials can stall reimbursements and burden providers with unnecessary administrative work. ERN leverages administrative laws, loopholes, and medical necessity protections to dispute wrongful denials, preserving your right to a disagreement of care and competent review by a qualified medical professional.
Incorrect coding, missing documentation, or payor-imposed technicalities can result in immediate denials, even when care was properly provided. Without a structured response, these denials can lead to lost revenue and excessive rework. ERN strengthens your mandate to advocate for medically appropriate healthcare per Wickline v. State, with compliance-driven audits, proactive tracking, and payor-specific strategies to prevent technical denials before they happen.
As denied claims age past payor deadlines, the chance of successful recovery decreases significantly. Lack of proper follow-up, payor delays, and slow responses often cause providers to write off legitimate revenue. ERN ensures persistent follow-ups, regulatory escalations, and expert appeals to recover aged denials before they result in permanent losses.
Payors frequently downcode or dispute Diagnosis-Related Group (DRG) classifications, reducing payments for high-cost inpatient stays. These denials lead to underpayments that can significantly impact hospital financials. Alongside your CDI department, ERN aggressively challenges DRG downgrades, enforces correct payment structures, and prevents revenue loss due to improper payor adjustments.
ERN’s Denials Prevention & Management services offer a comprehensive approach to addressing and preventing claim denials. By leveraging our expertise in healthcare regulations and claims management, we proactively address the root causes of denials, reduce administrative burdens, and improve your revenue cycle.
