Case studies
What goes wrong in billing, and how it gets resolved
Two kinds, always labelled. Named audits from the public record: the HHS Office of Inspector General’s published findings at real hospitals and health organisations, every figure quoted from the report. And worked examples for solo physicians and small clinics: composites of common situations, resolved step by step from our denial guides. Neither is a Soft Home Global client result.
Named audits, from the public record
None of these organisations is a Soft Home Global client, and Soft Home Global had no part in any audit. Where an organisation disputed a finding, its response is on the page.
The Ohio State University Hospital · Columbus, Ohio
When is modifier 59 not allowed?
OIG report A-05-18-00042, 22 May 2020 · 47 did not fully comply
MediGold (Medicare Advantage contract H3668) · Columbus, Ohio
When should a "history of" diagnosis code be used instead of an acute one?
OIG report A-07-20-01198, February 2024 · 189 not supported by the medical records
Lake Hospital System · Concord, Ohio
What documentation does Medicare require for inpatient rehabilitation facility claims?
OIG report A-05-19-00024, June 2021 · 51 did not fully comply
St. Francis Hospital · Peoria, Illinois
How should service units be billed on an outpatient surgery claim?
OIG report A-05-18-00048, October 2020 · 14 did not fully comply
Edward W. Sparrow Hospital · Lansing, Michigan
Can a hospital bill an emergency department E/M service for a patient who came in only for dialysis?
OIG report A-05-18-00045, 12 November 2020 · 91 complied, 9 did not fully comply
Bridge Home Health · San Diego, California
What causes home health claims to fail a Medicare audit?
OIG report A-05-23-00017, 19 December 2024 · 90 complied, 10 did not
Worked examples for small practices
Illustrative composites, not real practices. Each is resolved with the steps from the matching denial guide, and none claims a result.
Illustrative · CO-197
Why are procedures denied for missing prior authorization when the practice obtained one?
A solo pain management physician with one front-desk employee
Illustrative · N130
What does remark code N130 mean for a therapy practice?
A two-therapist outpatient physical therapy clinic
Illustrative · CO-16
How do you fix a CO-16 denial for missing claim information?
A three-provider family medicine practice
Illustrative · CO-29
Can a timely filing denial be overturned?
A small specialty practice whose only biller left
Illustrative · CO-231
What does "mutually exclusive procedures cannot be done in the same day/setting" mean?
A four-surgeon orthopedic group
Illustrative · CO-251
Why was a claim denied as documentation incomplete when records were sent?
An independent outpatient imaging center
Questions
Are these Soft Home Global client results?
No. The named cases are public audits of hospitals and health organisations by the HHS Office of Inspector General, quoted from the published reports; Soft Home Global had no part in them. The worked examples are composites of common situations, not real practices. No result on this page is claimed as ours.
Why not publish client case studies?
Because a case study with a client name needs that client's permission and real numbers behind it. Until a client authorises one, publishing named results would mean inventing them, and anything invented here would be checkable in one phone call.
Next step
See where your own claims stand
Send a ninety-day denial report and an aged AR summary, with no patient identifiers. Within two working days you get a written summary of which denial reasons are costing you most and what is recoverable.
Or write to ops@softhomeglobal.com