Denials and Appeals

Q: How do you handle clinical validation denials when payers say you won’t receive payment unless you remove a code from the claim? 

While communication is key to reducing denials, it’s very difficult to do well, according to Nancy Blattberg-Smith, MPH, RHIA, CDIP, CCS,

After receiving negative feedback from industry stakeholders on its new reimbursement approach for certain inpatient Medicare Advantage (MA) claims, Aetna recently extended the policy’s implementation date.

Review the latest claims processing instructions from CMS for telehealth and acute hospital care at home services.

Sourcing field-tested, reliable denials management processes is not a simple task.

Revenue integrity professionals came together for two days of empowering learning and networking at the 2025 Revenue Integrity Symposium (RIS).

Put your commitment to excellence into action.

Apply these lessons to reduce denials and support efficient processes.