Denials & Appeals

Although HCCs are not new, addressing risk-adjustment methodologies is becoming more frequent in both the acute and primary settings.Read More »

Q: What is a good strategy for sharing denials data with the medical staff to ensure they understand...Read More »

By Allen Frady, RN-BSN, CCDS, CCS, CRC

Be aware of payer’s “home cooked” clinical criteria which are often not only outdated, but...Read More »

by Allen Frady, RN-BSN, CCDS, CCS, CRC
More than a decade ago, I received a claim from patient financial services with a denial due...Read More »

by Trey La Charité, MD, FACP, SFHM, CCS, CCDS
Like it or not, provider documentation is the foundation for everything done in...Read More »

Q: What’s the difference between RACs, MACs, and the CERT?Read More »

Last week, the AHA submitted four, non-deadline related remedies to reduce the backlog of Medicare billing appeals awaiting adjudication at the...Read More »

By Allen Frady, RN-BSN, CCDS, CCS, CRC

Generally speaking, developing consistent query policies and procedures for both coding and...Read More »