Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Non-Medically Necessary vs. Statutorily Excluded Services: Understanding the Differences  Written by: Jennifer McNamara “That’s not covered.” It’s a phrase we hear all the time—but what does it really mean? There’s a definite distinction between non-medically necessary services and those that are statutorily excluded.  Understanding the difference between non-medically necessary and statutorily excluded services is essential…

Details

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services

Compliance, CPT, Payer Rules, Practice Management, Procedural Coding & Auditing, Revenue Cycle Management

Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!!   Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…

Details

The Auditor’s Role in Appeals: A Key Player in the Compliance Process

Career, Compliance, Payer Rules, Practice Management, Revenue Cycle Management

The Auditor’s Role in Appeals: A Key Player in the Compliance Process  Written by: Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI The appeals process is a critical component of health care compliance, ensuring that denied claims are appropriately challenged and reconsidered. When providers and health care organizations receive claim denials, they…

Details