HealthcareRevenueCycle

Prior Authorization Denials

Pre-Authorization Denials: A Significant Threat to Practice Revenue

Leave a Comment / August 2024, Denial Management

Denials due to missing or invalid prior authorizations are a major concern for healthcare providers. Prior authorization is a critical step in the healthcare claims process, ensuring that the planned treatment is covered by the patient’s insurance plan. When prior authorizations are missing or denied, claims are often rejected, leading to delayed payments and significant […]

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CD-10 Excludes Notes

ICD-10 Excludes Notes: A Crucial Aspect of Accurate Coding

Leave a Comment / August 2024, ICD-10

In the intricate world of medical billing, accurate ICD-10 coding is paramount. However, navigating the nuances of ICD-10 can be challenging, especially when encountering “Excludes” notes. These notes provide crucial guidance on appropriate code usage, but misinterpreting them can lead to claim denials and significant revenue loss. Understanding Excludes Notes: Excludes1 vs. Excludes2 The Impact

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Denial Code CO16

Denial Code CO16: Conquer Missing Information Denials

Leave a Comment / August 2024, Denial Management

Denial Code CO16 is a common issue for healthcare providers. It means the claim submitted is missing important information needed for processing. This can include missing or incorrect patient demographics, service details, or payer information. These denials not only delay reimbursement but also consume valuable staff time and resources. Understanding the Root Causes of CO16

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Denial Code CO 27: A Significant Threat to Your Practice’s Revenue

Leave a Comment / August 2024, Denial Management

Denial Code CO 27, which indicates that services were provided after the patient’s insurance coverage had expired, is a common and frustrating challenge for healthcare providers. These denials result in unpaid claims, impacting your practice’s cash flow and potentially eroding patient trust. Understanding the Root Causes of CO 27 Denials Several factors can contribute to

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Denial Code N130

Denial Code N130: Navigating Negotiated Discount Challenges

Leave a Comment / Denial Management, July 2024

Denial Code N130, often encountered in medical billing, indicates an issue with the application of negotiated discounts on a claim. This can occur due to errors in calculating or applying discounts, missing documentation, or non-compliance with contract terms. These denials directly impact your practice’s revenue and require careful attention to resolve. Understanding the Root Causes

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