Rethinking Denial Management: How Prevention Outperforms Recovery

Wednesday, September 30th | 12:00 PM EST

Coding is now the denial category that decides the margin. Coding related denials rose 26 percent across hospital outpatient and professional settings in 2025, on top of a 126 percent outpatient jump the year before, and they have passed eligibility, registration, and pre-cert as the top category. Payer audit at-risk dollars climbed 30 percent. Medicare Advantage RFI and medical necessity denials rose fivefold. Payers are taking longer to respond and down-coding high weight DRGs and high intensity ED codes automatically, which converts revenue leakage into False Claims Act exposure. Retrospective review cannot close a gap that opens before the claim leaves the building. What works is interrogating 100 percent of charges at code complete, when the fix still costs nothing.

What You Will Learn

• Why coding related denials overtook front-end categories, and which settings are absorbing the damage
• How automated payer down-coding creates compliance risk, not just lost reimbursement
• What governance around autonomous coding actually has to look like to hold up
• How pre-bill interrogation changes DRG accuracy, first pass pay rates, and days in AR
• What is new in eValuator, and how confidence scoring and financial impact prioritize the work

Who Should Attend:

Revenue cycle and revenue integrity leaders, HIM and coding directors, billing compliance leaders, and healthcare finance executives.

What You Will Take Away:

A pre-bill operating model to bring back to the program, grounded in MDaudit benchmark data from 4,500 facilities, along with a practical view of what charge-level accuracy looks like when it happens before submission rather than after.