Denials management has gained new urgency as payers adopt more aggressive tactics and hospitals continue to face revenue shortfalls. Learn how organizations are structuring denials management and reporting denials and appeals data.
Certain provider services such as acupuncture and cosmetic surgery are not reimbursed by Medicare. This article describes when and how to apply HCPCS modifiers for non-covered services.
Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program. This article breaks down components of a coding policy and compliance plan and approaches to monitoring coding quality.
Under certain circumstances, a service or procedure may be partially reduced or eliminated at the discretion of the physician. Read up on the correct application of hospital modifiers -52, -73, and -74 for reduced and discontinued procedural services.
Tracking denials data as a key performance indicator (KPI) can help identify gaps in provider documentation and create meaningful physician education. Learn how to leverage coding and CDI staff in tracking and managing denials data.
