Denials and appeals

Review three recent clinical and regulatory developments that are important for case managers to know about.

A scan of healthcare news sources or the Office of Inspector General work plan often finds psychiatry and mental health practices under scrutiny. Laurie Bouzarelos, MHA, CPC, reviews revenue cycle functions, provider contracting/credentialing, and coding and documentation tips to avoid denials.

Tiffany Ferguson, LMSW, CMAC, ACM, CEO of Phoenix Medical Management, gives advice on two common ethical scenarios in case management.

Apply these expert tips to develop processes to ensure appropriate use and billing of new Alzheimer’s medications.

When writing appeals for healthcare denials, being proactive and thorough can significantly improve the chances of overturning the denials.

Cardiopulmonary resuscitation (CPR) is a lifesaving treatment used when the heart or lungs cease to function. Whether CPR is conducted alone or with other services, Nancy Reading, RN, CPC, CPC-P, covers the various ways that CPR can be reported and how to do so.

CMS’ 2024 OPPS proposed rule, released in July, details major changes to price transparency requirements and proposes numerous changes to behavioral health reimbursement, coverage of dental services, and more.

Every facility wants to prevent denials. But in this short-staffed era, it can be difficult to consistently ensure that claims are accurate. 

Debra, a case manager, helps a patient who has undergone plastic surgery six times in the past six years.

Surveyors don’t always get it right. Learn how to contest deficiencies and get them reversed.