Denials and appeals

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.

Organizations must ensure their procedures are aimed at preventing and managing denials. One way to accomplish this is by looking for opportunities to involve other departments. Use these tips to improve interdepartmental denials management.

Healthcare providers know that denials are not a matter of if, but when. One way to prevent and manage denials is by looking for opportunities to involve other departments.

CMS developed the National Correct Coding Initiative (NCCI) to control improper coding and potentially inappropriate payment of Part B services. Review NCCI basics to ensure compliance with the latest coding policies.

Clinical validity denials occur when there is a lack of clinical evidence in the patient chart to support a billed diagnosis. Learn more about common reasons for these denials and how to defend against them.