Tag: denials

Medicare Advantage denials

Understanding the Rise of Medicare Advantage Denials: What Need to Know

Medicare Advantage (MA) plans, a type of private health insurance, have become increasingly popular among seniors. These plans offer additional benefits beyond traditional Medicare, but they also come with their own set of complexities.  One of the most significant issues faced by MA beneficiaries is Medicare Advantage denials for medical services. Recent data has revealed […]
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Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Top Tips to Optimize Your Cardiology Billing and Coding Process

Top Tips to Optimize Your Cardiology Billing and Coding Process

Cardiology Medical Billing and Coding Process: To effectively handle these changes, cardiology practitioners might have to keep themselves informed about the modifications in payment regulations, modify their billing procedures as needed, and employ novel methods to enhance their compensation. Cardiology billing and coding can be challenging due to various factors, such as the complexity of […]
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New Patient EM Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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Non-Coverage Denials

Non-Coverage Denials: Cause and Cure

Explanation of Medicare Benefits (EOB) error message 96 Non-covered charge was the No. 1 reason for claims denials in December in all of Medicare Jurisdiction H, according to the region’s Medicare Administrative Contractor (MAC). “Prior to performing or billing a service, ensure that the service is covered under Medicare,” Novitas Solutions says on their website. This should be […]
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