Duplicate denials can be a persistent issue that disrupts revenue flow in healthcare practices. One common reason is Remark Code 522, which indicates that a claim has been flagged as a duplicate—either because it was already processed or is currently under review. Practice managers and healthcare providers should understand the causes and solutions for this code […]
Say No to Duplicate Denials: Tackling Remark Code 522 Read More »
Denial code 246 is a critical roadblock in healthcare revenue cycles, indicating that a claim has been halted before adjudication and returned unpaid. This non-payable code often disrupts cash flow, and understanding its causes and solutions is essential for healthcare providers, practice managers, and clinic owners. Common Reasons for Denial Code 246 Strategies to Prevent
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Denial code 236 is a significant roadblock for healthcare providers, often caused by violations of the National Correct Coding Initiative (NCCI) guidelines or state-specific workers’ compensation regulations. This denial indicates that a procedure or procedure/modifier combination is incompatible with another service billed on the same day. Understanding how to navigate these coding rules is essential
Denial Code 236: Master NCCI and State Rules for Revenue. Read More »
Denial Code 39, which states “Services denied at the time authorization/precertification was requested,” is a frequent challenge healthcare providers face. This denial typically arises when medical procedures are performed without obtaining the necessary prior approval from the insurance carrier. Why Does Denial Code 39 Occur?Several factors can lead to Denial Code 39, including: Strategies to
Cracking the Code: Preventing Denial Code 39 Read More »
The CMS-1500 form, previously known as the HCFA-1500, is a standardized document that healthcare providers use to submit claims for reimbursement to government insurance plans like Medicare, Medicaid, and Tricare. This crucial form captures essential details about the patient, provider, services rendered, and insurance coverage, ensuring accurate and efficient claim processing. Key Sections of the CMS-1500The CMS-1500 form is divided into
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The recent loss of the Medicaid contract by Texas Children’s Health Plan (TCHP) presents significant challenges for healthcare providers in Southeast Texas. With nearly 450,000 members impacted, this development has the potential to disrupt practice revenue and patient care. Financial Impact on Healthcare Providers Impact on Patient Care and Access Preparing for Change: Strategies for
Texas Children’s Medicaid Loss: Impact & Strategies for Providers Read More »
Claim denials with the cryptic “B7” code are an all-too-common frustration for healthcare providers. This denial often points to issues with provider certification, which can lead to payment delays, wasted time, and added stress. Fortunately, understanding the causes behind B7 denials and taking proactive steps to address them can help you avoid unnecessary hurdles in
How to Prevent B7 Denials: A Guide for Healthcare Providers and Practice Managers Read More »
As a healthcare provider, navigating Coordination of Benefits (COB) can feel like solving a complex puzzle. When patients have multiple insurance plans, determining which payer is primary and which is secondary is crucial to getting paid. Incorrectly managing COB can lead to claim denials, particularly with the CO-22 code, which often stems from issues related
