Diagnosis Code Validation
We ensure all codes are specific and supported by proper documentation.
No vague codes. No shortcuts.
Denial Prevention
Fewer Denials. Faster Payments. Stronger Financial Health.
Denial Prevention: The Synergy Billing Difference
Most billing firms manage denials.
At Synergy Billing, we believe they should be prevented.
What Is Denial Prevention?
Denial Prevention is both an art and a science—and it’s one of the core disciplines that sets Synergy Billing apart. Rather than waiting for errors to happen and correcting them downstream, we focus upstream—learning from the past to build systems that prevent denials before they occur.
Denials are costly. They delay cash flow, increase the cost to collect, and reduce the likelihood of full payment. One out of every three claims denies due to preventable errors, and the average cost to appeal a denied claim can range from $25 to $118 per claim. Denial management alone is no longer enough.
The Myth of the “Clean Claim”
A common misconception is that a “clean claim” from the clearinghouse means everything is fine.
Not true.
Clearinghouses only validate format and basic structure—not the clinical specificity, coverage accuracy, or payer logic. This is why even “clean” claims can still be denied.
True denial prevention goes beyond clearinghouse edits.
Our Approach: Prevention by Design
At Synergy Billing, denial prevention is engineered into every step of our revenue cycle process. We integrate people, process, and technology to ensure accuracy before submission—because the best offense is a good defense.
Here’s how we do it:
Modifier Accuracy
We verify modifiers are payer-appropriate and supported by the procedure performed.
Coverage & Benefits Verification
We confirm eligibility and plan-specific rules before the claim is submitted.
Custom Rule Engine
We use proprietary technology to scrub data for common and payer-specific denial triggers—before submission.
Checks & Balances
We establish internal quality controls to catch issues that clearinghouses miss.
The Result?
Once optimized, our clients achieve >95% first-pass payment rates—dramatically reducing denials, accelerating cash flow, and lowering the cost to collect.
Denial prevention isn’t just a nice-to-have.
It’s a strategic advantage—and a hallmark of Synergy Billing’s commitment to excellence.
News & Insights
View AllBanishing the Billing Ghosts: Getting Paid, The First Time
Oct 13, 2025
In healthcare billing, nothing drains energy and revenue faster than rework. Every denied claim, every code mismatch, every missing modifier is like a ghost tugging at your bottom line — invisible at first, but costly over time. For FQHCs, where margins are tight and missions are big, getting it...
The Ghost in The Machine — The Unseen Glitches That Haunt Your Revenue Cycle.
Oct 13, 2025
Welcome to the ghost in the machine — the unseen glitches that haunt your revenue cycle. The Unseen Impact of Updates When vendors like NextGen, Epic, or eClinicalWorks push updates, even minor tweaks to file structures, NPI mapping, or claim fields can create cascading issues. A single change in...
The Rising Cost of Claim Denials and How FQHCs Can Protect Their Bottom Line
Sep 30, 2025
Healthcare providers are facing a mounting challenge: claim denials are on the rise, and they’re taking a serious toll on both revenue and patient care. According to Experian’s 2025 State of Claims report, more than 41% of providers now say that 10% or more of their claims are denied, up from 38%...
How Outsourced Billing Partnerships Drive Long-Term Growth for FQHCs
Sep 23, 2025
Rethinking Billing as a Growth Strategy Too often, FQHC leaders think of medical billing as a cost center — a necessary function that ensures providers are paid. But when done right, billing can actually become a driver of long-term financial growth. The key is choosing an outsourcing partner who...
Forecast Your Patient Service Revenue
Most health centers don’t know how much revenue should be coming in. Synergy Billing offers a complimentary revenue analysis using your historical claims data to forecast expected revenue, identify gaps, and set accurate targets.
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