The someday drawer: what happens to the 50–65% of denials nobody works

Every practice has one. It may be a literal folder, a work queue in the practice management system labeled something optimistic, or just a status code that claims enter and never leave. It is the someday drawer: the place denied claims go when everyone agrees they should be worked and nobody has time to work them. The drawer feels harmless because nothing in it ever demands attention. That is precisely the problem. Denied claims do not escalate. They do not call. They just quietly expire.

How much is actually in the drawer

The honest national answer is: most of the denials. Per MGMA data, 50% to 65% of denied claims are never reworked or resubmitted. Read that carefully. It does not say half of denials lose their appeals. It says half to two-thirds never get a first rework attempt of any kind. And the flow into the drawer is accelerating: in MGMA's 2024 Stat Poll, 60% of medical groups reported higher denial rates in 2024 than in 2023. More denials arriving, the same staff to work them, and an unworked share that was already a majority. The drawer is not shrinking.

Recoverable is not the same as worthless

The instinct that excuses the drawer is that denied claims are dead money, not worth the fight. The data says otherwise. Advisory Board research puts roughly two-thirds of denied claims in the recoverable category. Combine the two figures and the picture is stark: the majority of denials are never touched, while the majority of denials are winnable. Those two majorities overlap. A meaningful share of what sits in your someday drawer is money a payer would have released if someone had sent the right documentation, corrected the right code, or simply resubmitted within the filing window.

There is a legitimate cost argument for triage. MGMA, HFMA, and Change Healthcare estimates put rework at roughly $25 per denied claim, over $100 per formal appeal, and as high as $118 to $181 at the top end. A $40 denied copay-adjacent balance genuinely may not justify an hour of a biller's time. But triage means sorting by expected value and working the winners. What most practices actually do is sort by nothing and work whatever surfaces before the day runs out. That is not triage. That is drift.

Why the drawer keeps filling

The mechanics are mundane. Front-of-cycle work always wins the competition for staff time, because new claims have visible deadlines and denials do not appear to. The administrative load elsewhere is crushing: per the AMA's 2024 Prior Authorization Report, physicians and their staff already spend an average of 13 hours per week on prior authorization alone. When the same two or three people handle eligibility, prior auth, charge entry, and denials, denials lose every single day, because they are the only queue where the consequence of neglect is invisible for months.

But denials do have deadlines. Every payer contract carries appeal windows, commonly 60 to 180 days from the denial date, and timely filing limits behind those. A denial that sits in the drawer past its appeal window converts from an asset into a permanent write-off, silently, with no notification. The drawer is not a holding pattern. It is a conveyor belt with a cliff at the end, and the cliff is contractual.

This is an industry-scale problem, which means payers have priced it in

Providers are not losing this fight for lack of effort in aggregate. AHA and Premier analysis estimated that hospitals and health systems spent $19.7 billion in a single year fighting denials. That figure tells you two things. First, denial management is now a core operating cost of American healthcare, not an edge case. Second, and more usefully for an independent practice: payers operate in an environment where a large share of denials are never contested. A denial that goes unworked costs the payer nothing. Whatever the intent behind any individual denial, the economics of the system reward issuing them, and the someday drawer is the mechanism that delivers the reward.

The triage math that empties the drawer

Run a simple hypothetical. Suppose your drawer holds 400 unworked denials averaging $350 in billed charges: $140,000 in gross exposure. Apply the Advisory Board finding that roughly two-thirds of denials are recoverable, discount for the ones past their appeal windows and the ones that will lose anyway, and even a conservative operator might expect to collect a meaningful five-figure sum from a drawer like that, against rework costs measured in the tens of dollars per claim. The exact numbers depend entirely on your payer mix, denial reasons, and how long the drawer has been accumulating. That is the point: you cannot know what the drawer is worth without opening it and counting.

That counting exercise is exactly what our Recovery Audit does: a $500 analysis we currently run free for a limited number of practices each month. We inventory your unworked and aged denials, sort them by recoverability and remaining appeal runway, and put a defensible dollar figure on the drawer. It ends with a written go/no-go: either the recoverable value clearly justifies a recovery engagement, or it does not and we say so in writing. Either way, the drawer stops being a mystery, and it cost you nothing to find out.