1. Inaccurate Patient Registration

The foundation of revenue cycle success

Accurate patient registration remains the cornerstone of effective revenue cycle management. Studies show that roughly 25–30% of denials stem from front-end registration and eligibility mistakes. When essential details are missing or incorrect, claims are more likely to be rejected or delayed.

To minimize risk, ensure the following data is collected and verified before the time of service:

• Full legal name, address, and date of birth
• Guarantor details (financially responsible party)
• Insurance information including payer name, member ID, group number, and plan effective/termination dates
• Subscriber details (if different from the patient)

Capturing both front and back images of the patient’s insurance card is crucial for clean claims. Many payers use third-party administrators (TPAs) for final adjudication, and complete card details ensure accurate routing and communication.



If obtaining a physical card isn’t possible—such as in telehealth or offsite care—use a patient face sheet or other documents containing insurance details. Practices can also request limited payer access for staff or deploy system integrations to reduce manual entry errors.

2. Missing or Incomplete Insurance Card Copies

Even the most accurate demographic data can’t offset an incomplete insurance record. Missing card details often result in claims sent to the wrong payer or pricing delays. Always scan both sides of each patient’s insurance card to capture policy, claims, and network details. For remote settings, verify coverage from digital or system-stored documentation to maintain accuracy and speed.

3. Outdated Eligibility Verification Processes

Manual phone-based eligibility checks are a thing of the past. Inaccurate or missed eligibility verification can lead to avoidable denials for inactive coverage, terminated plans, or non-covered services. Invest in real-time eligibility verification (RTE) within your practice management system (PMS).

Modern RTE tools—especially those with AI capabilities—instantly confirm active benefits, plan details, copays, and deductibles. This enables staff to resolve discrepancies before the patient encounter, ensuring payment efficiency from the start.



4. Inadequate Pre-Submission Claim Validation

Automated claim edits should be your first line of defense against denials. Configure system edits to identify potential issues such as:

• Medical necessity mismatches
• Medically unnecessary procedures
• Mutually exclusive CPT or HCPCS codes



These proactive edits catch common coding and billing mistakes before claim submission, significantly improving clean claim rates.

5. Delays in Claim Submission and Rejection Management

Even well-prepared claims can lose momentum if not submitted promptly or followed up efficiently. Establish automated daily claim submission workflows and track rejections in real time. Address rejected claims immediately to avoid processing delays.

A high-performing billing operation should target a First Pass Resolution Rate (FPRR) of 95% or higher. Consistent claim monitoring and rapid correction prevent revenue loss and ensure steady cash flow.

Key Takeaway

Reducing claim denials starts long before the claim reaches the payer. By prioritizing accurate patient registration, leveraging technology for verification and edits, and proactively managing claims, practices can significantly reduce errors and boost reimbursement efficiency.

Implementing these front-end and back-end improvements ensures cleaner claims, faster payments, and a smoother path toward revenue cycle excellence in 2026.