Why MSOs Inherit Denial Chaos
Every practice a management services organization acquires arrives with its own denial handling habits — its own spreadsheets, its own informal escalation rules, its own relationship (or lack of one) with appeal deadlines. Multiply that across 50, 80, or 150 locations and the result isn't really 'inconsistent process.' It's 50 to 150 different processes running in parallel, most of them undocumented, some of them nonexistent.
This is one of the least glamorous but most financially consequential integration problems an MSO faces. Denial handling doesn't show up as a line item in most acquisition models, but a practice that was appealing 40% of its denials pre-acquisition and drops to 15% post-acquisition because process ownership got fuzzy during transition is a real, measurable revenue leak.
The Standardization Trap: Over-Centralizing Kills Specialty Nuance
The instinctive MSO response is to centralize everything into one denial team at the platform level. This solves the consistency problem but often creates a new one: a centralized team covering dermatology, urgent care, and orthopedic surgery across dozens of locations can't hold the clinical nuance any single specialty needs to write a strong appeal.
The practices that get this right tend to standardize the process — intake, tracking, deadlines, escalation, reporting — at the platform level, while keeping clinical and coding judgment closer to the specialty or the individual practice. Standardize the skeleton; keep the specialty-specific muscle local.
A Framework: Common Core, Specialty Layer
A practical version of this looks like a shared 'common core' every acquired practice adopts within the first 90 days post-close: a single tracking system, a single set of deadline rules by payer, a single escalation path when an appeal is denied twice, and a single reporting format that rolls up to platform leadership.
On top of that core, each specialty or practice group maintains its own documentation checklists and medical necessity language — informed by what actually works for that specialty's payer mix, but built on the same shared infrastructure rather than a separate system.
Metrics MSOs Should Track Across the Portfolio
At minimum: percentage of denials appealed (not just paid — appealed at all, since unappealed denials are the biggest silent leak), appeal-to-payment rate by specialty and by payer, average time from denial to appeal submission, and dollars recovered per FTE hour spent on appeals. Tracked consistently across every location, these four metrics surface both underperforming practices and systemic payer issues far faster than practice-by-practice anecdote.
Change Management: Getting Acquired Practices to Adopt a Shared Process
The technical design of a standardized process is usually easier than getting 50 practices' existing billing staff to actually use it. Adoption tends to go better when the new process is framed as making their job easier — faster packet assembly, less manual tracking — rather than purely as a compliance requirement from the platform. Practices that feel like standardization is being done to them resist it; practices that experience it as a tool that reduces their workload adopt it faster.
ResolveRCM gives MSOs a single, trackable appeal workflow that scales across every acquired location while still adapting to each specialty's documentation needs — without a heavy integration lift. Learn more. |