Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Payer Recoupments and Takebacks: What to Do Between the Letter and the Offset
A recoupment starts as a letter or a strange line on a remittance and ends as money withheld from unrelated claims. The steps in between, and the deadlines attached to them, decide whether the practice keeps the money, repays it on its own terms, or loses track of it entirely.
How to Write a Medical Necessity Appeal That a Payer Reviewer Will Actually Read
A CO-50 denial is not the end of the claim; it is a request for an argument. Here is the structure we use for medical necessity appeals, the deadlines by payer type, the documents to attach, a worked example, and the mistakes that get well-supported services denied twice.
How to Run a Fourth-Quarter Denial Review, Including the Timely Filing Check
A fourth-quarter denial review has one purpose: recover what can still be recovered in 2024 and stop the same denials from following you into January. Here is the report set, the buckets by cause, the timely filing audit that belongs in the same week, a worked example, and how to turn the findings into three fixes.
How to Build a Denial Dashboard Your Practice Will Actually Use Every Week
Most practices have denial reports nobody reads. A denial dashboard is different: eight fields captured on every denial, six numbers reviewed weekly, and a category scheme that points at the process that failed. Here is how to build one in a spreadsheet, with a worked example, before you buy software.
Eligibility Verification Without a Clearinghouse During the Medicaid Unwinding
Eight weeks after the Change Healthcare attack, many practices still cannot run electronic eligibility, and the Medicaid unwinding has disenrolled more than 18 million people, mostly for paperwork reasons. Here is how to verify coverage by hand and work the eligibility denials piling up.
Writing Denial Appeal Letters That Actually Get Read and Overturned
Most appeal letters fail before a reviewer reaches the second paragraph. Here is the structure we use, the three denial types where a letter is worth writing, the documents to attach, the deadlines to log, and the mistakes that get an otherwise good appeal sent back unread.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.