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Denial Code 96: Understanding and Preventing Non-Covered Service Denials

Leave a Comment / August 2024, Denial Management

Denial code 96 is issued when a billed service, procedure, or item is not covered under a patient’s insurance plan. These denials can result from policy exclusions, incorrect coding, or lack of pre-authorization, leading to payment delays and lost revenue for healthcare providers. For practice managers, billing teams, and healthcare providers, understanding the root causes […]

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CO45 Denials: Why They Happen and How to Prevent Revenue Loss

Leave a Comment / August 2024, Denial Management, Healthcare

CO45 denials can be a major financial setback for practice managers, healthcare providers, and medical billing teams. This denial occurs when the billed amount exceeds the payer’s maximum allowable fee, leading to reduced reimbursements and increased administrative burdens. Understanding its causes and implementing proactive solutions can help optimize your revenue cycle and improve profitability. Common

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Denial Code 131: How to Prevent Revenue Loss and Optimize Your Billing Process

Leave a Comment / August 2024, Denial Management

Denial code 131, “Claim specific negotiated discount,” is a frequent yet avoidable issue for healthcare providers and practice managers. Left unresolved, it can significantly impact revenue cycles, leading to lost reimbursements and financial strain. By understanding its root causes and implementing proactive solutions, you can enhance claim approval rates and strengthen your practice’s financial health.

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Denial Code N130: Overcoming “Benefit Not Covered” Claims & Boosting Your Revenue

Leave a Comment / August 2024, Denial Management

Denial Code N130, often encountered in medical billing, signifies that the service provided was not covered by the patient’s insurance plan. This can stem from various reasons, including benefit exclusions, policy limitations, or coding errors. These denials not only impact your practice’s cash flow but also erode patient trust and satisfaction. Understanding the Root

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Out-of-Network Denials: A Significant Threat to Practice Revenue

Leave a Comment / August 2024, Denial Management

Denials for services provided by out-of-network providers are a common challenge for healthcare practices. These denials occur when a patient receives care from a provider who is not part of their insurance plan’s network. This can lead to significant financial losses for the practice and increased out-of-pocket costs for patients. Understanding the Root Causes of

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PAR vs. Non-PAR: Navigating Medicare Participation and Optimizing Revenue

Leave a Comment / August 2024, Healthcare

Choosing to participate in Medicare as a healthcare provider (PAR) or remain non-participating (non-PAR) has significant implications for your practice. This decision impacts reimbursement rates, patient flow, and overall revenue. Understanding PAR and Non-PAR Status The Impact on Your Practice Optimizing Your Revenue Cycle Regardless of your participation status, robust revenue cycle management is crucial

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

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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