For U.S. clinics, claim denials remain one of the biggest revenue drains, costing providers billions in lost reimbursements annually. In fact, the average denial rate for hospitals in 2025 stands at 11.6%, with mid-sized practices experiencing even higher rates. The good news? Most denials are preventable with proactive strategies and the right support. SPS Health specializes in denial prevention, clean claim submissions and revenue cycle optimization, helping practices recover what they’re owed.
Why Denials Are Still on the Rise
Despite investments in revenue cycle systems, payer complexity and documentation errors remain top contributors to claim denials. The Change Healthcare cyberattack in early 2025 revealed just how fragile revenue workflows can be, impacting millions of claims and slowing reimbursements across the U.S.
Other leading causes of denials include:
- Eligibility errors (unverified insurance at the time of service)
- Incomplete or inaccurate coding
- Missed prior authorizations
- Untimely filing
According to MGMA’s 2025 Financial Benchmarks report, over 60% of denials are preventable with better front-end processes.
5 Strategies to Reduce Claim Denials
- Verify Eligibility Upfront
Insurance verification at the time of scheduling can eliminate a large portion of denials. SPS Health provides real-time eligibility checks integrated with your scheduling and billing platforms.
- Automate Prior Authorizations
With payers tightening prior authorization rules, automation is essential. SPS Health leverages API-enabled tools to streamline approval workflows, cutting authorization-related denials significantly.
- Optimize Coding Accuracy
Incorrect coding accounts for a substantial portion of rejected claims. Our team of certified coders ensures compliance with 2025 CMS and payer-specific rules, reducing recoding and resubmission efforts.
- Monitor and Analyze Denial Trends
Analytics-driven denial tracking allows practices to spot patterns, whether it’s payer-specific denials or recurring documentation gaps and take corrective action.
- Appeal Aggressively and Early
When denials do occur, timely appeals are critical. SPS Health manages appeals proactively, often recovering revenue that would otherwise be written off.
The SPS Health Difference
By partnering with SPS Health, practices benefit from:
- End-to-end denial management, from front-end verification to back-end appeals
- Custom dashboards tracking denial trends and recovery rates
- Expert guidance on payer-specific compliance to reduce rejections
Our clients have reported up to 35% fewer denials and improved days in A/R by 20–25% within the first six months of partnership.
Final Thoughts
Denials don’t just impact cash flow, they disrupt your entire revenue cycle. With proactive denial prevention and a strong RCM strategy, you can protect your revenue and keep operations running smoothly.
SPS Health offers clean claim submissions, denial trend analytics and end-to-end revenue recovery to keep your practice financially healthy.
If you have any questions regarding “denial management or revenue cycle support”, feel free to contact us. For inquiries, Email us at: info@spshealth.net.
Disclaimer: The above information is subject to change and represents the views of the author. It is shared for educational purposes only. Readers are advised to use their own judgment and seek specific professional advice before making any decisions. SPS Health is not liable for any actions taken by readers based on the information shared in this article. You may consult with us before using this information for any purpose. For further assistance, please contact us.
