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Ronnie Guha

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Category: Operations

A few healthcare operations tips for you, based on my experiences from the field

Handling prior authorization related denials

If you find out that a procedure requires prior authorization by the patient’s plan, immediately move the appointment to an “appointments at risk” bucket.

Categorized as OperationsTagged medical billing

Handling denials due to medical necessity documentation

Create a list that shows you the medically necessary (deemed) CPT for the related CPT that you are submitting in the claim. You might even need to consult with your provider to get further information on this as well

Categorized as OperationsTagged medical billing

Handle medical claims denials caused by bundling

You need to be careful of what you report “together” on the same date. You cannot also unbundle and submit the claim with multiple provider names from the same practice. 

Categorized as OperationsTagged medical billing

Handle medical claims denials due to Incorrect data entry

Usually, the practice management system will do part of the work but it is never 100% correct and your charge posting team and the medical coding team will have to provide their inputs as well.

Categorized as OperationsTagged medical billing

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