Denials & Appeals

Recently, we’ve seen an uptick in clinical validation denials regarding acute pulmonary insufficiency and acute respiratory failure following...Read More »

The Office of Inspector General (OIG) performed a provider compliance audit of...Read More »

An important step toward preventing malnutrition denials on the front end is...Read More »

Are institutions appealing sepsis denials if the patient meets sepsis-2/super systemic inflammatory response syndrome (SIRS) criteria, but not...Read More »

I was wondering if anyone had experience with denials from commercial payers that goes beyond the third level of appeals. We are getting response...Read More »

A Humana health plan in Florida overcharged Medicare by nearly $200 million in 2015 by incorrectly billing for high severity...Read More »

Sunrise Hospital & Medical Center in Winchester, Nevada, submitted Medicare claims for rehabilitative services that did not comply with...Read More »

by Brian Murphy

The Office of the Inspector General (OIG) dropped their latest bombshell. It concerns the...Read More »

Findings from an Office of Inspector General (OIG) audit show that Blue Cross...Read More »

A report from the Office of Inspector General (OIG) shows that Medicare billing...Read More »