Why Are Medicare Advantage Plans Rarely Fined for Wrongful Denials?
A JAMA Health Forum study found CMS fined Medicare Advantage plans $616,366 for 22 wrongful denial violations since 2021, none for medical
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Stop paying for the same denial twice
Most practices rework denials one at a time. The claim gets paid and the cause survives. This playbook shows you how to find the three denial patterns carrying most of your denied dollars, and how to close them at source.
WeBill Health White Paper
The Denial Root Cause Playbook
How to find the three denial patterns costing your practice the most, and close them at source
5 pages | webillhealth.com
What is inside
Written for the person who has to fix it, so it stays practical the whole way through.
- The four root causes, namedFront end authorization, documentation alignment, coding specificity and payer policy drift, with the CARC codes each one shows up as on your remittance.
- How to find your own top three patternsA spreadsheet method you can run in an afternoon. Group by CARC, payer and CPT together, rank by dollars, and read the top three.
- What the pattern looks like in your billing typeSeparate breakdowns for office visit and consultation billing, time based therapy billing, and procedure and surgical billing.
- A quarterly checklist you can run without usSix questions. If you cannot answer one of them, that is the gap costing you money right now.
Send me the playbook
One email address. We send the download link straight away.
Who this is for
Practice owners and billing managers at independent practices where denials are running above 10 percent, where nobody owns payer policy changes, or where the same rejection keeps arriving with a different patient name on it.
It is a working document, not a brochure. If you read it and fix the problem yourself, that is a good outcome.
Questions
Denial Root Cause Playbook questions
What are the four root causes of recurring denials?
Front end authorization, documentation alignment, coding specificity and payer policy drift. Each one shows up under its own CARC codes on your remittance.
How do I find my own top three denial patterns?
Group your denials by CARC, payer and CPT together, rank the groups by dollars, and read the top three. The playbook walks through the method step by step.
Who is the playbook for?
Practice owners and billing managers at independent practices where denials run above 10 percent, where nobody owns payer policy changes, or where the same rejection keeps coming back.
Is the playbook free?
Yes. Enter one email address and the download link arrives straight away.
Reviewed by Tyler Nguyen, Denial Defense Manager, WeBill HealthLast updated September 28, 2026
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