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.
Category: Operations
A few healthcare operations tips for you, based on my experiences from the field
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
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.
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.