What Denials Are Telling You About Your Front-End Ops

What Denials Are Telling You About Your Front-End Ops

Most denials don’t start in billing. They start in appointment setup, eligibility, and auth workflows.

If your write-offs are creeping up and the usual spot checks aren’t moving the needle, it’s time to treat denials as signals—not mistakes.

Your front-end processes are likely introducing billing risk before the patient even shows up. Here’s how to trace it.

1. Eligibility Errors That Shouldn’t Be Happening

CO-27 and CO-29 denials aren’t payer surprises. They’re operational misses. The most common issue? Eligibility was verified once—at time of scheduling—and never again.

Look deeper:

• Pull a sample of 25 same-day or next-day visits from last week. What % had eligibility re-run within 4 hours of check-in?
• Are walk-ins or reschedules bypassing standard eligibility workflows?
• Are you capturing plan details but missing payer-specific carve-outs (e.g. mental health, lab-only coverage)?

Quick fix: Set up a daily eligibility recheck batch job or assign ownership to a designated pre-visit QA.

2. Authorizations Are Flagged—But Still Missing

Your system might prompt for auth, but is it CPT-specific? Many PM/EHR systems only flag at the visit level. That’s not good enough for multi-line claims with mixed service types.

Watch for:

• Services scheduled under a global visit type (e.g. “Consult”) with buried CPTs that require auth
• Intake staff checking auth status at scheduling, but failing to verify that the auth was approved, not just “requested”

Pro tip: Review your recent CO-197 denials. Crosswalk them with the actual CPTs billed and see how many weren’t auth-flagged upstream.

3. Visit Type Configurations Driving Code-Level Denials

What’s selected at scheduling drives what shows up in billing. If your visit type templates are stale or mismatched, you’re guaranteeing conflict codes and delayed payment.

Example:
A “Follow-Up” visit scheduled in the EHR defaults to a 99213, but the provider performs minor surgery and documents a 11401. If your front desk didn’t flag it or the coder didn’t catch the mismatch, expect a CO-50 denial or modifier miss.

Try this:

• Audit 10 recent visits where modifiers -25 or -59 were applied. How often was the visit type a mismatch for the actual services rendered?
• Sit in on scheduling for 1 hour. Are schedulers defaulting to catch-all visit types out of habit?

Fix: Align visit types to most common billing pathways. Set hard stops or alerts for outlier combinations.

Next Step

Denials are telling you exactly where to look.
BettyWell helps clinics build a denial trace map—connecting billing outcomes to upstream workflow gaps. We’ve helped teams cut CO-27s and CO-197s by 20–30% just by fixing setup processes.

Book a 20-minute Ops & Revenue Review to walk through your top 3 denial codes and surface what’s really driving them.