22 MINDenial-Proof Billing: How to Protect Practice Revenue at Every Stage
Claim denials quietly drain revenue from independent practices every day. A single eligibility error or missing modifier can trigger rework, delayed payments, and staff time spent chasing down payers instead of serving patients. This episode examines how Tebra is helping practices shift from reacting to denials to preventing them entirely.
Kevin Clinton, Director of Marketing for Billing and Payments, speaks with product managers Laura Araya and Megan Jernigan about the tools and workflows that protect revenue at every stage of the billing cycle. The conversation starts with the fundamentals: why eligibility verification matters more in small practices where one or two billers handle everything, and how real-time checks prevent denials before services are even rendered. From there, the team walks through code scrubbing that catches NCCI edits and medical necessity issues, claim attachments that now reach over 200 payers proactively, and reporting tools that help billers identify their costliest denial patterns.
The discussion closes with a practical look at AI—not as hype, but as pattern recognition that adapts to changing payer rules faster than humans can update static workflows. For billing teams tired of manual follow-up and preventable denials, this episode offers a clear-eyed view of what’s possible today and what’s coming next.
- Real-time eligibility checks cut eligibility-related denials and let your front desk collect patient responsibility upfront, so train staff to run checks before every visit.
- Running a code scrub (NCCI edits, medical-necessity logic, modifier rules) at charge entry prevents the bulk of coding denials and reduces time spent on rework.
- Proactively attaching supporting documentation with the initial claim—especially for moderate/high-complexity E/M and unlisted codes—avoids medical-record requests and speeds payer adjudication.
- Use denial summary and insurance-collections reports to surface the top denial reasons by dollar value, then fix those upstream (front desk data entry, prior auth workflows, or clinical documentation).
- Deploy AI-enabled tools to flag and prioritize claims likely to deny—letting a 1–2 person billing team focus on appeals and high-value follow-up while automation handles repetitive fixes.
Kevin Clinton is the Director of Marketing for Billing and Payments at Tebra and the host of this episode of Tebra Talks. He guides the conversation on clean claim rates and denial prevention, covering eligibility, code scrubbing, claim attachments, status tracking, reporting, and the potential role of AI in improving billing workflows.
Laura Araya is a Billing Product Manager at Tebra focused on front office and mid-cycle workflows. In this episode, she explains why eligibility verification is a critical first step for preventing denials, outlines common coding errors, and describes how Tebra's code scrubbing supports cleaner submissions. She also breaks down the difference between RPA and AI and discusses how AI can help adapt to changing payer rules and predict denials before claims are submitted.
Megan Jernigan is a Billing Product Manager at Tebra focused on back office insurance collections and payment posting. She defines clean claim rate, reviews common denial drivers such as eligibility, prior authorizations, and timely filing, and discusses how denial impact differs for small practices versus large systems. She also covers documentation and claim attachment workflows, claim status follow-up challenges, and the reporting tools practices can use to monitor denials and improve performance.
