Drafting an effective appeal in response to payer audits and overpayment demands goes beyond just coding and billing; it also often requires a deeper analysis and technical response. Discover methods to improve your appeals strategy with an eye on facts and compliance.
Q: As utilization review case managers, we are often tasked with assessing our hospital's risk for novel coronavirus (COVID-19) denials. What are the most important measures we should be examining?
Determining which denials could be overturned on appeal is key to a successful denial management program. Learn how to leverage your appeal team's knowledge to create a data-driven scoring system.
Judith L. Kares, JD, writes about the unique coverage, billing, and payment rules that apply to these blood products and related services under Part B.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a rich source of data. Consider how to use the PEPPER to guide coding and CDI process improvements.
