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
What a MAC Prepayment Review Actually Is A Medicare Administrative Contractor prepayment review is a formal medical record audit that occurs before Medicare pays a claim rather than after. When a claim is selected for prepayment review, payment is suspended while the MAC requests clinical documentation to verify that the service meets Medicare’s coverage, coding, … Read more
Why the 2026 OIG Work Plan Demands Immediate Attention The Office of Inspector General of the US Department of Health and Human Services publishes and continuously updates a Work Plan that identifies the programs, services, and billing patterns it intends to audit. The 2026 Work Plan is not a prediction of where enforcement might eventually … Read more