Denied claims remain a significant hurdle in healthcare revenue cycle management (RCM). For hospitals, health systems, labs, and ambulatory surgery centers (ASCs), each denied claim means more than just delayed payment, it adds administrative work, strains staff resources, and, if unresolved, can result in lost revenue.
When it comes to addressing denials, organizations typically take one of two paths: keeping the work in-house or partnering with an outsourced RCM specialist. Both approaches have advantages, and the right choice depends on your organization’s resources, goals, and long-term strategy.
Understanding the strengths and limitations of each option can help you find the most effective way to protect revenue and reduce the burden on your teams.
In-House Denials Management
For many organizations, keeping denials management in-house feels both natural and practical.
Internal staff are deeply familiar with your systems, workflows, and payer contracts. They can quickly collaborate with clinicians, coding teams, and finance leaders to resolve documentation questions or make real-time adjustments. That level of direct control is valuable, and in-house management can be effective for organizations with strong RCM infrastructure.
The challenge is that denials are becoming more complex and frequent. In fact, in 2023, nearly 1 in 5 in-network claims were denied.
Regulations change, payer requirements evolve, and keeping up requires ongoing training and technology investment. For many teams already balancing patient access, billing, and compliance responsibilities, giving denials the dedicated attention they need can be challenging. Even the most capable internal staff may find themselves stretched thin when claim volumes spike or when backlogs grow faster than they can be resolved.
In-house management works best when the team has the right mix of expertise, technology, and bandwidth. But when those pieces are strained, organizations often begin exploring additional support through new tools, external resources, or a hybrid model that relieves pressure without replacing internal strengths.
Outsourced Denials Management
Outsourcing doesn’t mean replacing your internal team; it means extending it.
Partnering with an end-to-end RCM service provider means access to a dedicated group of professionals who can focus solely on denials management. These teams bring specialized expertise developed from working with multiple providers and payers, giving them insight into emerging denial trends and effective appeal strategies that can complement your internal knowledge.
The scalability of outsourcing is especially valuable. If you’re facing seasonal spikes, staffing shortages, or a mounting backlog, an outsourced partner can step in to provide immediate relief and long-term stability. Many also bring advanced analytics, automation, and AI-driven tools that help identify denial root causes and implement fixes upstream (capabilities that may not always be feasible to build in-house).
By taking on the heavy lift of denials, an outsourcing partner frees up your internal team to focus on patient care, access, and other strategic initiatives. In this way, outsourcing serves as an extension of your workforce, not a replacement.
Why More Organizations Are Making the Shift
Denials management has become a specialized discipline, and outsourcing offers:
- Faster turnaround on appeals and recoveries.
- Lower operational costs compared to hiring, training, and retaining in-house teams.
- Actionable intelligence from denial trend data to improve processes across the revenue cycle.
While in-house control can feel comfortable, the scale, speed, and sophistication of modern denials management often demand more than internal resources can sustainably deliver.
Some organizations choose a hybrid approach, retaining high-complexity or high-dollar claims in-house while outsourcing routine or backlog work. This allows internal teams to focus on the most sensitive cases while benefiting from the efficiency and expertise of an external partner.
Choosing the Right Path
When deciding between in-house and outsourcing, consider:
- Your current denial rate and backlog size.
- Staff capacity and skill level to manage denials effectively.
- Technology capabilities for analytics, automation, and prevention.
- The cost of missed recoveries versus the investment in external expertise.
If you find your team always catching up rather than staying ahead, outsourcing may not just be the best option; it may be the sustainable one.
Take the First Step Toward Better Denials Management
Whether you’re dealing with a mounting backlog or simply want to prevent denials before they happen, the right partner can transform your results.
SYNERGEN Health offers end-to-end denials management that combines expert teams, advanced technology, and a proactive approach to help your team recover more revenue, faster.
Wondering where you stand and how outsourcing could improve your denials management performance? Request an RCM assessment.
