Shelley C. Safian, PhD, RHIA, CCS-P, COC, CPC-I, unpacks local and national medical necessity standards and best practices for avoiding denials due to inadequate documentation.
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.
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.
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.
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.
