What denial reason codes are worth appealing every time?

Timely filing denials with proof of on-time submission, correctable coding errors, and eligibility denials where the patient was actually covered are worth appealing regardless of dollar amount. These are process failures, not judgment calls, and they win fast.

Is there a hard dollar amount below which a practice should always write off a denial?

No single number works for every practice. The right cutoff is the point where your average rework cost exceeds claim value times realistic win probability. For most practices that lands between $75 and $150, well below the $500 mark this framework is built around.

How long do practices typically have to appeal a denied claim?

Commercial payers usually allow 90 to 180 days from the denial date, and Medicare allows 120 days for a redetermination. Check the exact window on the explanation of benefits before deciding.

What is the average cost to rework a denied claim?

Industry benchmarks put the cost to rework a single denied claim between $25 and $118, depending on complexity and whether a peer-to-peer review is required. This cost applies whether the appeal wins or loses.

Should a practice appeal a medical necessity denial on a low-dollar claim?

Only if the same CPT code and payer combination is likely to recur. A single low-dollar denial often costs more to appeal than it recovers, but a repeating pattern justifies the fight even when today’s claim doesn’t.

Does writing off a denied claim mean giving up on collecting it?

Yes, for that specific claim, but it doesn’t mean ignoring the root cause. The denial reason should still get logged so the same mistake doesn’t generate the next ten write-offs.

Who should make the appeal or write-off call in a practice?

Front-line billing staff can apply the framework for routine, low-complexity denials. Anything involving medical necessity, a peer-to-peer review, or a large balance should go to a billing manager or RCM partner first.

Appeal or Write Off? A Decision Framework for Denied Claims Over $500

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