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.
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.
Tracking denials data as a key performance indicator (KPI) can help identify gaps in provider documentation and create meaningful physician education. Learn how to leverage coding and CDI staff in tracking and managing denials data.
As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) toInterQual.
