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Topic

Denials

10 articles on denials — what the work involves, what to organize before handing it to anybody, and how to tell whether it is working. No gates and no email capture.

  • How to write an appeal letter that actually gets a claim reopened

    Most appeals ask the payer to please review the claim, and most are denied twice. The four parts that change that, and where each comes from.

    Denials 3 min read

  • What a denied claim actually costs to work, and what it costs to ignore

    Two published figures decide it: what a rework costs, and how much of a denied claim is eventually paid when worked. Both are checkable.

    Denials 2 min read

  • How to overturn a timely filing denial

    A timely filing denial is not always final, and the thing that overturns it is almost never an argument. It is a record showing the claim arrived on time.

    Denials 3 min read

  • How eligibility verification actually works

    Most of what a practice loses to coverage problems is decided before the patient arrives. This is what a dedicated eligibility seat checks, when it checks it, and how to set the queue up so the front desk stops finding out at the counter.

    Eligibility 7 min read

  • How prior authorization works, start to finish

    Authorization work fails in the gap between submitting and deciding. This is how to staff the chase, what to record, and how to stop authorizations expiring quietly before the service is rendered.

    Prior authorization 6 min read

  • How denial management works, and what it costs to skip

    Reworking denials one at a time is labour. Classifying them is the part that stops next month’s. This is how to run a denial queue that does both, and what to define before handing it to anybody.

    Denials 7 min read

  • How charge entry and claim submission work

    Charge lag is the cheapest problem in the revenue cycle to fix and the least often measured. This is how a dedicated charge entry seat runs, what it should scrub before submission, and what has to be decided first.

    Revenue cycle 6 min read

  • How medical coding works in a practice

    Coding is the one back-office function where being fast and wrong is worse than being slow. This is how to set up an outsourced coding seat so the record leads and the query process actually works.

    Operations 5 min read

  • How DME billing works, and why documentation decides it

    In durable medical equipment the claim is the easy part. The documentation file behind it decides whether the claim survives, and it has to be complete before the item ships.

    Revenue cycle 4 min read

  • Why insurers deny claims, and which denials are worth fighting

    Most denials are recoverable and most are never worked. The published data on denial rates, what it costs to fight one, and how to decide which to chase.

    Denials 2 min read

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