Working Denials vs Preventing Them: Why Accountability Beats Effort
There is a version of denial management that looks like hard work and produces almost nothing. A team works the queue every day, appeals what it can, resubmits, calls the payer, and the denial rate next quarter looks exactly like last quarter. One of the practice leaders on our recent panel named it perfectly: you can work like a mouse on a wheel and not get anywhere.
That was Jana Fullbright, Director of Revenue Cycle at State of Franklin Healthcare Associates, and she has a blunter version of the same point. You can throw people at a problem, she said, but it does not fix the problem. Her own team had learned that the expensive way, with people stacked on the back end fixing the same denials over and over. The work got done. The number did not move. More hands on a recurring problem buys you a faster lap, not a different race.
The practices that actually move the number treat prevention as a discipline, not a task. Three habits separate them.
They fix causes, not claims
First, they fix causes, not claims. Working a denial resolves one claim. Finding why that denial keeps happening, and changing something upstream, resolves the next hundred. In the session, the examples that worked all traced a denial back to its origin: an order set, a front-desk step, a documentation gap, a provider pattern. The denial was the symptom. The fix lived earlier in the process.
Finding the cause depends on how the work is organized, a detail most practices never revisit. Fullbright’s team separated their denial queues by specialty and by denial type rather than by payer. The logic is practical. A given denial type gets worked the same way every time, whether it is eligibility or diagnosis, so grouping them makes the work faster. It also makes the pattern visible. Once similar denials sit side by side, you can see whether the trouble is concentrated in one payer, and that is a question you cannot ask when the queue is sorted by payer to begin with.
Claim scrubbing is where prevention gets built in
The most concrete prevention mechanism anyone described was a pre-bill claim scrubber, and the story is mostly about what did not work. Fullbright’s practice added one when they moved to a new practice management system two years ago. It arrived with a cookbook of rules already written, which she describes as great and fine, and which did not solve her problems. Generic rules are generic. They have to be critiqued against how your own practice actually bills.
So the team got into the weeds. She has lost count of how many rules they have added since. Some are mundane and valuable, like reordering diagnoses when the one that needs to be primary was entered third or fourth, so the scrubber moves it. Others came out of specialty work, like a set of modifiers the diagnostics team realized were missing. Her verdict on the off-the-shelf version is worth quoting: if they had just used the cookbook, it probably would not have fixed any of those things. They had to make it personal.
That is the difference between owning a claim scrubbing tool and doing claim scrubbing. The tool is a place to put what you have learned. It does not come knowing your practice.
Jacot described wanting exactly this and not having it. His wish is a red light before the claim ever reaches the insurer, something that says this particular payer will deny this for these specific reasons, so his team can fix it before it goes out. He knows the rules change constantly and no system will be right every time. He also knows the alternative is finding out 60 days later.
It is owned across the organization
Second, prevention is owned across the organization, not parked in billing. As the panel put it, this is not one team’s job. The clinicians, the front desk, the coders, and the billing office all touch the revenue, so prevention only sticks when each of them owns their piece. A denial caused at intake cannot be solved at the clearinghouse.
Fullbright’s version of shared ownership is a standing meeting, at least monthly, with the specialty teams. The charge entry person sits down with the insurance person working that same specialty, and together they decide whether another rule would stop the error at the source. The format matters more than it sounds. Her description of the alternative is where most practices actually are: one team drowning while the other team does not even know there is a problem. Nobody is hiding anything. The information simply has no route between them.
Someone confirms the fix held
Third, and this is the one most teams skip, they measure whether the fix held. It is not enough to retrain people and hope. The leaders who were getting results built a loop: make the change, then run the report that tells you whether denials in that category actually went down, and assign someone to confirm it. Accountability is the difference between a change and a correction.
What changes when the loop is working is not only the denial rate. Fullbright’s practice needed fewer people on the back end, and the people still there spend their time on new problems rather than the same recurring ones. You will always have denials, she is clear about that, and you still need people sharp enough to spot a new issue when it appears. The shift is in what those people are for. Her old position was that some things could not be fixed. That is no longer the stance. They can be fixed, if someone gets into the weeds.
What prevention cannot do
An honest version of the denial prevention argument has to admit where it stops. Jacot’s hardest denials are not process failures at all. A payer decides it will not pay for the angiogram and the treatment on the same day, so a patient gets two procedures instead of one. Another decides that if you treat three blood vessels it will pay for one. Authorization requirements push him toward a CTA he does not need, which means extra radiation for the patient and extra cost for the insurer. No claim scrubbing rule prevents a policy change, and as he points out, the third parties paid to audit for errors keep rereading their own rulebook and revising it.
His answer is not a better tool. It is to find good partners and to confirm by audit that what you believe is working actually is. Having somebody else look at your work is, in his words, an easy one liner.
None of this requires a new platform to begin. It requires choosing one category, finding the cause, assigning an owner, and checking the result. Effort is not the scarce resource in most practices. Direction and accountability are.
If you want to see how other independent practices are building that discipline, the full session and the 2026 survey are a good place to start.