tci General Surgery Coding Alert - 2023 Issue Q3

Appeals: Use These 5 Tactics to Halt Denials

Prevent future errors by noticing current patterns. If you hate filing appeals for claims denials, you can turn lemons into lemonade by using the experience to learn from prior mistakes and enhance your surgery practice’s profitability. Background: Denials have been steadily on the rise since 2016, according to Holly Ridge, BSN, RN, CPC, CPMA, manager of medical necessity and authorization denials for Duke Health in Durham, North Carolina. But even with the average appeals success rate of about 40 to 45 percent, correcting denials can translate to a substantial return on investment (ROI) depending on the services your...

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