Why Chasing High-Dollar Denials Misses the Biggest Yield Opportunity
Chris Spady reframes the denial prevention priority question at Erlanger Health: high-dollar claims get the most attention, but those claims often deny consistently and predictably, which means resources spent chasing them can be less productive than focusing on prevention upstream. A $250 claim that denies because of something preventable wastes a resource that could be applied to higher-value work, and the same payer-edit failure will repeat across thousands of similar claims. In aggregate, those low-dollar denials represent a larger yield improvement opportunity than a smaller number of high-dollar denials that were always going to be difficult to win.
Key Takeaway
Denial prevention yield is driven more by volume than by individual dollar size. Focusing exclusively on high-dollar claims leaves thousands of preventable low-dollar denials on the table, and it is that aggregate, across thousands and thousands of claims, that represents the largest untapped improvement in revenue cycle performance.
“It’s your lower dollar claims that drive yield. If you really want to improve yield, you’re probably not going to do it quickly with high-dollar claims, but you can do it with thousands and thousands of low-dollar claims.”
Chris Spady, Senior Vice President of Revenue Cycle, Erlanger Health
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