Denial prevention checklist
Pick your specialty and get the checks that stop its denials before the claim goes out — each one taken from the code it came from, each linking back to it. 47 specialties. Free, nothing stored, nothing invented.
Pain Management — 5 checks
The pattern is worth more than the individual claim. If the same CPT and diagnosis pair is being denied repeatedly, the fix is in how the visit is documented, and that is worth telling the clinician.
Because: RFA denied because the chart does not carry percent relief and duration from both diagnostic blocks
CO-16 is a volume problem, not a difficulty problem. It is cheap to fix per claim and expensive in aggregate, which is exactly the kind of work that never gets done by a busy front desk.
Because: Bilateral procedures billed without the correct modifier
SCS trials denied for missing psychological evaluation
Facet injections exceeding payer frequency limits within a rolling year
This is a scrubber problem more than a knowledge problem. If the same code and modifier pair fails twice, the rule belongs in the claim edit rather than in somebody’s memory.
Because: Units billed per level when the payer pays per region
Tick them here to work through it once, or copy it as text and put it where the claims are actually built. The ticks are not saved anywhere — nothing on this page is transmitted or stored.
What this list is, exactly
Each line is the prevention step written on that denial code’s own page, paired with the sentence from Pain Management’s denial list that matched it. It is what this site names for that specialty — not a measurement of what any practice is denied most, because we have never counted a denial anywhere and will not present a figure as though we had.
The pairing is deliberately conservative: a sentence that matches no code is left out rather than attached to the nearest one, because a wrong code on a checklist is worse than a short checklist. Every code, with its causes and fixes.
Appeals are the expensive way to be right
An appeal is a letter, an attachment, a wait and a second wait, and on the published figures it costs $57.23 per claim in administrative time before anybody knows whether it worked. The same denial prevented costs one question asked at the right moment — was the authorisation on the claim, was the size documented before the closure, was the plan of care recertified.
Nobody forgets those questions because they do not know them. They forget because the list lives in somebody’s head, and the person building the claim on a Tuesday is not that somebody. A list that can be put on a wall is the entire intervention.
Questions
How do you prevent claim denials?
Denials are prevented upstream of the claim, not appealed downstream of it — an authorisation obtained before the visit, a size documented before the excision is closed, a plan of care recertified before it lapses. The checks that matter are specific to what a specialty actually bills, which is why this tool asks for yours rather than offering one list for everybody.
Where do these checks come from?
Each one is the prevention step written on that denial code’s own page on this site, paired with the sentence from your specialty’s denial list that matched it. Nothing is generated. Every item links to the page it came from so you can read the full argument before putting it on a wall.
Is this the most common denial list for my specialty?
No, and the page says so. It is what this site names for that specialty. We have never counted a denial at any practice and will not present a figure as though we had. The pairing is also deliberately conservative — a denial sentence that matches no code is left out rather than attached to the nearest one.
Can I print it or put it in our workflow?
Yes. Copy it as text and put it wherever claims are actually built. No attribution needed and nothing to sign up for, though a link back is how anybody else finds it.
A list on a wall only works while somebody is watching it
The checks that hold are the ones somebody owns — authorisations chased before the date of service, eligibility verified before the visit, denials categorised so the same reason stops recurring. That is a seat's work, full time, on your hours, inside your own system.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to ops@softhomeglobal.com and skip the form entirely. What happens to it.
Next step
Prevention is the cheap half
The other half is the queue that already exists. Send ninety days of aged AR and see what is recoverable in it, in writing, before you pay anything.
Or write to ops@softhomeglobal.com