From Denials to Dollars: Collecting Lost Revenue in Radiology Practices
How radiology groups can collect more dollars on denied claims
Radiology practices are increasingly at the center of healthcare’s growing denial and reimbursement crisis. Mounting scrutiny around prior authorizations, medical necessity, and coding accuracy is resulting in radiologists facing a disproportionate share of administrative burdens and some of the highest denial rates in healthcare. According to the American College of Radiology (ACR), nearly 15% of claims submitted to private payers are initially denied, resulting in delayed reimbursements, costly rework, and meaningful revenue loss.
In a specialty defined by high volume and rapid turnaround, even a small increase in denials can have an outsized impact, which is why effective denial management is critical.
Radiology denials: a unique set of challenges
While all specialties face claim denials, radiology is particularly vulnerable due to the nature of its services. High-cost imaging studies often require prior authorizations and detailed documentation to justify medical necessity – areas that are heavily scrutinized by payers. Yet radiologists rarely control these processes. When referral documentation is incomplete or authorizations are missed, the radiology group absorbs the denial. These operational gaps highlight the need for comprehensive denial management that drives down initial denial rates.
Beyond the first rejection: initial vs. net denial rates
To truly manage denials, radiology groups need to track both initial denial rates and net denial rates. Initial denial rates reveal how many claims are rejected on first submission, often due to preventable front-end errors or missing documentation. But the net denial rate tells the full story: the percentage of claims never paid or resolved, even after appeals or corrections.
High-performing RCM teams are laser-focused on driving down net denials by identifying root causes and implementing targeted fixes, which may include tighter authorization workflows, robust documentation protocols, and advanced analytic platforms that flag at-risk claims in real time. When net denial rates are high, it’s a sign that revenue is being left on the table.
Fewer denials. More revenue.
Health Prime consistently outperforms industry benchmarks, delivering lower initial and net denial rates, resulting in stronger collections for our clients.
Denial management that delivers
Health Prime combines technology-enabled services, advanced data analytics, and hands-on performance reviews to help radiology groups recover revenue lost to initial claim denials. From small practices to large groups, our proven approach works across practice sizes and EMR platforms to reduce avoidable denials, speed up payments, and strengthen overall financial performance.
Client success stories
Turning denials into dollars for a large practice
A large radiology client had a gross denial rate of 5.28%. By leveraging data-driven insights and deploying a proactive denial management plan, Health Prime reduced their net denial rate to just 0.89% – a level rarely seen at this scale.
In one quarter, the denial rate improvement generated over $150,000 in recoverable revenue, collected over the following months, putting the practice on track to gain more than $600,000 annually, directly boosting the group’s bottom line.
99.11%
Percent of claims resolved by Health Prime.
Big financial win for a small radiology practice
A small radiology client was experiencing a low initial denial rate of 5.01%. Through targeted denial management and process enhancements, Health Prime further reduced the practice’s net denial rate to just 1.22%.
When annualized, this improvement translates into a six-figure increase in revenue from previously denied claims that can now be reinvested into operations, care delivery, or provider compensation.
98.78%
Percent of claims resolved by Health Prime.
Finding an RCM partner that delivers
In radiology, where denials can quickly erode margins, your billing partner’s approach makes all the difference. The complexity of imaging services, coding requirements, and prior authorization rules demand a partner that provides comprehensive denial management. From submitting clean claims that result in low initial denial rates and identifying trends, to actively addressing and resolving denials, you need a full scope denial management partner, who can:
- Leverage technology to lower initial denial rates
- Tech-enabled payer-specific edits and automated scrubbing tools help prevent errors before claims are submitted.
- Execute resolution efforts
- Denial-specific actions and recovery strategies reduce the number of claims that ultimately go unpaid.
- Implement proven workflows to drive down net denial rates
- Structured follow-up and excalation processes reduce the number of claims that ultimately go unpaid.
- Utilize analytics to prevent future denials
- Data-driven insights reveal patterns and root causes, helping to stop denials before they happen.
“Health Prime is 100% customer focused and will go out of their way to help their clients.”
-Radiology Practice Administrator
Customized denial management for every radiology group
Whether you’re an independent imaging center or a large radiology group with hundreds of physicians, denial management should never utilize a one-size-fits-all approach. The most effective billing partners combine the technology and scale to handle volume with the flexibility to tailor strategies to your workflows, systems, and payer mix.
With denials rising across radiology, having the right denial management infrastructure is essential. Radiology groups that prioritize denial prevention and resolution will be better positioned to navigate evolving payer policies, stabilize cash flow, and protect revenue from preventable loss.
Health Prime is a leading provider of revenue cycle management solutions for radiology groups. With a team of 5,000+ employees across the U.S., Latin America and Asia, we accelerate reimbursements for thousands of physicians nationwide. To learn how we can help your radiology practice improve operational efficiency and financial performance, please visit hpiinc.com/radiology.
