What A Healthy Denial Rate Looks Like In Eye Care

Every denied claim is money you've already earned but haven't been paid for. Most of it still gets paid eventually, but only after someone on your team finds it, figures out what went wrong, fixes it, and sends it again.

Where The Line Sits

Your first-pass denial rate is the share of claims that come back denied the first time you send them. Well-run practices keep it at 5% or less. Published industry averages tend to land between 5% and 10%, and anything above that usually means the same few problems are repeating every week.

What It Costs

A practice collecting $85,000 a month with a 12% denial rate has roughly $6,000 a month more going through rework than a practice at 5%. That money isn't lost, but it's delayed, and every reworked claim takes staff time. Some never get resubmitted at all.

Most Denials Start At The Front Desk

When practices sort their denials by reason, the same handful show up again and again: coverage that changed since the last visit, a missing or outdated insurance ID, the wrong plan billed for the type of visit, or a missing authorization. Very few are true coding disputes. Most can be stopped before the patient ever sits in the exam chair.

Try This Week

Pull last month's denials and group them by reason. Pick the single biggest group and build a quick check for it into check-in. For most practices, that's an eligibility check on every patient at every visit, not just new ones. Then compare next month's denial rate to this month's.

Want to see where your denial rate sits next to your other numbers? Run the free checkup and Iris will show you in about two minutes.