Denials and appeals

Get back to the basics of sepsis documentation to combat the increasing rate of denials.

Use these tips to train your team on the latest definitions and coding guidance for diabetes screening and related services during your next training session. 

Ensure your queries are solid enough to protect your organization against denials.

Make sure staff who handle audit requests understand when a missing signature should — or should not — trigger an automatic denial of your claims or prior authorization requests. Recent guidance from CMS clarifies how auditors should proceed when a medical record lacks a signature.

Review updates in the 2025 Medicare Advantage (MA) and Part D final rule that could impact case management practices.

Kepro recently updated its discharge appeal process, bringing with it more work and new questions for case managers.

Follow the case of a patient who refuses to transfer until certain conditions are met.

Ensure your organization is keeping pace with current and upcoming requirements for price transparency compliance.

Shelley C. Safian, PhD, RHIA, CCS-P, and Mary A. Johnson, MBA-HM-HI, CPC, review the purpose of modifiers and analyze their integral part in reporting encounters, receiving reimbursement, and promoting continuity of care.

Alysia Minott, CCS, CIRCC, CDIP, explains anatomic and documentation details coding professionals need to know to report cardiac and interventional radiology procedures.