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Jakob Emerson | October 16, 2023
With the Medicare open enrollment period underway, some seniors may have fewer provider choices in their respective regions as hospitals and health systems across the country increasingly cut ties with the Medicare Advantage program ...
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Nina Youngstrom | September 18, 2023
When Erica Remer, M.D., was a young physician, the way she knew a patient with an infection had sepsis was “you walked into the room and got the sinking feeling the person would die from this infection ...
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Nina Youngstrom | July 26, 2023
Although the wheels of administrative justice moved slowly for a set of Medicare claims ...
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Phillip Baker, M.D., Bill Hayes, Kendall Smith, M.D. | June 26, 2023
Although the world opened up for hospitals and other providers with the April regulation that requires ...
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2024 Medicare Advantage and Part D Final Rule
Denise Wilson, MS, RN, RRT | April 11, 2023
On April 5, 2023, CMS issued their final rule on Medicare Advantage (MA) and Part D plans...
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Knowing When and How to Fight the Good Fight
Tiffany Ferguson, LMSW, CMAC, ACM and Denise Wilson MS, RN, RRT | March 20, 2023
The need for benchmarking denials is evident...
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Lawrence A. Laddaga, JD, FHFMA, and Julia Dandridge | April 26, 2022 | From the HFMA
Strategic alternative dispute resolution offers providers key...
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Nina Youngstrom | June 27, 2022
Report on Medicare Compliance, Volume 31, Number 23, Published by the Health Care Compliance Association, Eden Prairie, MN
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Taryn Schraad | April 5, 2022
Not to mince words, but medical insurance claim denials are a “thorn in a provider’s side.” Meticulously getting the the admission or diagnostic services authorized or approved, then providing care and treatment to the...
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R. Kendall Smith, MD, SFHM Chief Physician Advisor, Intersect Healthcare
Quite often appeal writers are faced with the challenge of...
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Breen Nabors, RN, CCDS |
March 30, 2021
The dreaded denial letter comes across your desk disputing a major diagnosis that undoubtedly will...
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Malissa Powers, BS, RHIT, CCS, CDIP, CICA | July 7, 2020
Although the payer should provide a detailed explanation as to why the...
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Karla Hiravi, BSN | June 10, 2020
In the medical denials and appeals world, a clinical validation audit is done to ensure billed diagnoses and conditions are validated by the...
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Denise Wilson | October 28, 2019
There is never a reason to write an appeal letter from scratch unless you are writing your very first...
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Denise Wilson | October 28, 2019
Including payer coverage guidelines in your appeal letter templates can increase the efficiency and...
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