tci Medicare Compliance & Reimbursement - 2019 Issue 1
Appeals: Analyze Your Denials to Improve Your Appeals Odds
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Article Overview
This article discusses practical appeal workflow considerations for medical billing and coding staff who handle claim denials. It focuses on reviewing denial remarks, checking for bundling and documentation issues, supporting appeals with regulations and contract-related context, involving the patient when appropriate, requesting peer review, staying timely, and sending appeals to the correct department. The guidance is aimed at practices that want to understand denial handling at a higher level without relying on repetitive resubmissions.
Why This Topic Matters
Denials can be costly and time-sensitive, and the article highlights the kinds of review steps that may help a practice better understand why a claim was denied and how to organize a more informed appeal process.
What You Will Learn
- How denial remarks and explanation-of-benefits information can inform an appeal review
- Why bundling and documentation issues are common areas to examine after a denial
- How regulations and contractual context can support an appeal submission
- When patient involvement and peer review may be relevant to the denial process
- Why appeal timing and departmental routing matter in follow-up workflows
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance staff
- Practice administrators
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