Denials and appeals

Coding managers should not assume that they can review every coding guideline, Coding Clinic, or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits.

Hospitals have made avoiding and managing denials a top priority, but for many their best efforts have yet to turn the tide.

Clinical validation denials can be complex and difficult to appeal. Improve your process by using these tips to craft a clinical validation appeal.

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.

Fran Jurcak, MSN, RN, CCDS, CCDS-O, looks at how machine learning can improve efficiency in the middle revenue cycle.

Tiffany Ferguson, LMSW, ACM, and Marie Stinebuck, MBA, MSN, ACM, CEO and COO at Phoenix Medical Management Inc., discuss why the best strategy to prevent denials related to medical necessity is a proactive approach that focuses on front-end processes.

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.

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.

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.