Tag: Payer Policies

medical necessity documentation

Medical Necessity Documentation: A Guide to Reducing Claim Denials

Claim denials are a significant headache for healthcare providers, impacting revenue and administrative efficiency. While denials can stem from various issues, a large majority are rooted in documentation errors, particularly those related to demonstrating medical necessity. Defining Medical Necessity: The American Medical Association (AMA) defines medical necessity as healthcare services or products provided to a […]
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Healthcare Claims Management

Healthcare Claims Management: Overcoming Denials and Optimizing Revenue Cycle

Claim denials continue to pose a significant challenge to healthcare claims management. Recent surveys indicate a substantial increase in denial rates, with many providers experiencing denial rates exceeding 10%. This issue has far-reaching consequences, impacting operational efficiency, financial stability, and ultimately, patient care The High Cost of Denials Healthcare providers face substantial financial losses due […]
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Healthcare Claim Denials

Reduce Healthcare Claim Denials and Improve Revenue: Proven Strategies

Healthcare Claim Denials can be a frustrating and costly setback. However, with the right strategies, you can significantly reduce denials and improve your revenue. This article outlines four effective approaches to handling denied claims and ensures timely resubmissions. 1. Establish a Routine for Denial Handling Create a standardized procedure: Develop a clear and efficient process […]
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CPT Modifier

Six Tips to Getting Paid for CPT Modifiers

In medical coding, CPT modifier are vital for accurate reimbursement of healthcare services. These special codes, attached to primary procedure codes, provide additional details about the complexity or extent of a service. However, using modifiers incorrectly can lead to claim denials and lost revenue. This blog post shares six key tips to help you get […]
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