Denials and Appeals

Denials management is critical for providers facing rising denial rates, especially in medical necessity claims, which can delay cash flow and increase appeal costs.

 
To maintain financial stability and operational efficiency, healthcare organizations must enhance clinical...

Denial prevention continues to be a top priority in today’s healthcare revenue cycle. From optimizing claim submission to activating an appeals plan, you’ll get every action item you need to prevent and overturn denials — plus key metrics to track as you go.

This sample policy was provided to the National Association of Healthcare Revenue Integrity (NAHRI) by Erin Brearley Cutter, MBA, CHRI, CRCR, COC, CPC, revenue integrity director at Concord Hospital Health System in New Hampshire.

Kimberly A. Hoy, JD, CPC, explains recent changes to prior authorization rules for Medicare Advantage payers and how they affect hospitals.