BC Advantage - 2023 Issue 3

Overcoming Code Denials in Healthcare

Denial rates are rising because of numerous factors, including the increasing complexity of coding guidelines, increased workloads and staff shortage, adoption of AI and automation in payor claim reviews, increasingly sophisticated remittance processes, and more. However, taking a more granular review of your claims may help avoid significant revenue hurdles or other more serious headaches, like audits.  Traditionally, providers were not as concerned with the initial diagnosis, as under a fee-for-service model. What was important was getting the CPT accurate for provider billing and the final DRG for facility billing. With the shift to value-based care and...

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