Revenue Cycle Management guides covering claims submission, denial management, appeal strategies, documentation best practices, and billing workflow optimization.
One of the most common reasons a legitimate, separately payable service gets denied isn’t a coding mistake. It’s a misunderstanding of what’s already bundled into the surgery itself. The global surgical package is the single biggest source of CO 97 denials tied to surgical billing, and it trips up experienced coders just as often as … Read more
A corrected claim isn’t the same thing as a new claim, and billing it like one is the fastest way to get it rejected, denied as a duplicate, or stuck in limbo for weeks. Payers need to know you’re replacing something they already processed, not submitting a brand new charge. That distinction lives in one … Read more
Introduction: The Conflict Between Commercial and Medicare Billing Rules Medical billing professionals who handle coordination of benefits claims frequently encounter a challenging scenario: a global imaging code such as CPT 74181 (MRI abdomen without contrast) was correctly billed and paid by a commercial primary insurer, but the claim must now be submitted to Medicare as … Read more
The Gap Between What Providers Document and What Payers Need Medical necessity is the single most cited reason for claim denial across every payer type in the US healthcare system. The 2025 State of Claims report from Experian Health identified insufficient documentation as a top cause of denials, with denial rates reaching between 10 and … Read more
Why Surgical Prior Authorization Failures Cost More Than Any Other Denial Type Prior authorization denials for surgical procedures are the most expensive denial category in medical billing, not because individual claims are larger than other service types, but because the downstream consequences compound quickly. A surgical claim denied for missing or invalid prior authorization typically … Read more