33 articles matching “denial”.
Showing 1 to 24 of 33
Medicare Advantage billing differs fundamentally from traditional Medicare: MA plans have their own fee schedules, prior authorization requirements for services traditional Medicare never requires PA for, HCC risk adjustment coding requi...
EHR vs. PMS functional distinctions and overlap at charge capture, integrated suite vs. best-of-breed standalone approach trade-offs, key features to evaluate including eligibility verification, claim scrubbing, ERA auto-posting, denial...
Scheduling and pre-registration information capture to prevent downstream denials, insurance eligibility verification timing and 270/271 transaction workflow, prior authorization management including PA matrix maintenance and tracking, p...
Days in AR calculation and benchmark targets by practice type, denial rate vs. first-pass rate measurement, clean claim rate improvement strategies, net collection rate vs. gross collection rate distinction, cost to collect benchmarking...
Fee-for-service vs. Medicaid managed care billing differences, EVS eligibility verification and monthly verification requirements, FQHC and RHC Prospective Payment System billing, Medicaid MCO claim submission and enrollment, and most co...
PA tracking and workflow management from submission through renewal, PA submission documentation quality, peer-to-peer review and appeals strategy, electronic prior authorization (ePA) implementation, and Gold Carding and PA reform legis...
Denial root cause analysis framework, technical denial prevention (eligibility, PA, scrubbing), clinical denial appeals process, timely filing management, and denial management KPIs including prevention rate and overturn rate.
AR aging analysis framework, payer-specific follow-up strategies, denial working workflows, patient AR and self-pay collections, clean claim rate benchmarks, and write-off policy development.
AI in prior authorization and eligibility, RPA for RCM automation, AI-assisted coding tools, predictive denial management, and how to evaluate RCM technology vendors.
Gastroenterology billing covers colonoscopy CPT codes 45378-45398 including polyp removal by snare and hot biopsy forceps, screening vs. diagnostic colonoscopy ACA preventive benefit distinction, EGD codes 43235-43270 with biopsy and abl...
Neurology billing covers EEG codes 95812-95830, EMG and nerve conduction studies 95860-95913, botulinum toxin injection codes 64612-64647 with J-codes J0585-J0588 and NDC documentation, lumbar puncture 62270, evoked potential studies, an...
Plastic surgery billing covers the reconstructive vs. cosmetic coverage distinction and documentation requirements, skin graft CPT codes 15100-15278 with area-based measurement, local and free flap closure codes 14000-15758, breast recon...
Behavioral health billing covers psychotherapy CPT codes 90832-90838 timed code thresholds and add-on structure, psychiatric diagnostic evaluation 90791 vs. 90792 prescriber distinction, psychiatric E&M medication management, psychothera...
Radiology billing covers technical component and professional component split billing with Modifier TC and Modifier 26, diagnostic imaging CPT codes for X-ray CT MRI and ultrasound, interventional radiology catheterization and drainage p...
Sports medicine billing covers joint injection codes 20600-20611 with and without ultrasound guidance, hyaluronic acid J-code billing for knee OA, trigger point injections 20552-20553, PRP 0232T patient billing and ABN compliance, concus...
Sleep medicine billing covers polysomnography CPT codes 95782-95811 with TC/PC split billing, home sleep apnea testing 95800-95806 medical necessity and HSAT vs. PSG selection, CPAP and BiPAP DME codes E0601-E0471 with Medicare 90-day co...
Podiatry billing covers nail care codes 11719-11765, Medicare routine foot care exclusion Class Finding documentation and Q-modifier Q7 Q8 Q9 selection, bunionectomy 28290-28299 and hammertoe 28285 surgical global period management, diab...
Infectious disease billing covers HIV management E&M complexity documentation with ICD-10 coding B20 vs. Z21, OPAT infusion administration codes 96365-96368 with antibiotic drug J-codes, inpatient consultation billing for Medicare and co...
Pathology billing covers surgical pathology levels 88300-88309 by specimen complexity, immunohistochemistry codes 88342-88344, cytopathology and Pap smear coding 88141-88175, molecular pathology Tier 1 codes 81161-81408 and Tier 2 codes...
Core claim processing capabilities, EHR integration, reporting and analytics, denial management features, clearinghouse relationships, and total cost of ownership evaluation.
Six sequential steps, baseline measurement, gap analysis, front-end strengthening, coding optimization, denial prevention, and continuous improvement infrastructure.
Predictive denial prevention, AI-enhanced eligibility verification, intelligent claim editing, and AI-assisted denial management, where AI delivers the most measurable value.
Four core competencies separating billing professionals from beginners: payer-specific expertise, denial management, AR follow-up discipline, and data-driven improvement.
A systematic plan covering PA requirement tracking, proactive management, clinical documentation, authorization tracking, and structured appeals to cut auth denials.
