Knowledge Center
Resources focused on denial prevention and appeal success.

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Nina Youngstrom | September 18, 2023
When Erica Remer, M.D., was a young physician, the way she knew a patient with an infection had sepsis was “you walked into the room and got the sinking feeling the person would die from this infection ...
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Nina Youngstrom | July 26, 2023
Although the wheels of administrative justice moved slowly for a set of Medicare claims ...
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Phillip Baker, M.D., Bill Hayes, Kendall Smith, M.D. | June 26, 2023
Although the world opened up for hospitals and other providers with the April regulation that requires ...
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2024 Medicare Advantage and Part D Final Rule
Denise Wilson, MS, RN, RRT | April 11, 2023
On April 5, 2023, CMS issued their final rule on Medicare Advantage (MA) and Part D plans...
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Knowing When and How to Fight the Good Fight
Tiffany Ferguson, LMSW, CMAC, ACM and Denise Wilson MS, RN, RRT | March 20, 2023
The need for benchmarking denials is evident...
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Lawrence A. Laddaga, JD, FHFMA, and Julia Dandridge | April 26, 2022 | From the HFMA
Strategic alternative dispute resolution offers providers key...
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Nina Youngstrom | June 27, 2022
Report on Medicare Compliance, Volume 31, Number 23, Published by the Health Care Compliance Association, Eden Prairie, MN
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Taryn Schraad | April 5, 2022
Not to mince words, but medical insurance claim denials are a “thorn in a provider’s side.” Meticulously getting the the admission or diagnostic services authorized or approved, then providing care and treatment to the...
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R. Kendall Smith, MD, SFHM Chief Physician Advisor, Intersect Healthcare
Quite often appeal writers are faced with the challenge of...
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Breen Nabors, RN, CCDS | March 30, 2021
The dreaded denial letter comes across your desk disputing a major diagnosis that undoubtedly will...
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Malissa Powers, BS, RHIT, CCS, CDIP, CICA | July 7, 2020
Although the payer should provide a detailed explanation as to why the...
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Karla Hiravi, BSN | June 10, 2020
In the medical denials and appeals world, a clinical validation audit is done to ensure billed diagnoses and conditions are validated by the...
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Denise Wilson | October 28, 2019
There is never a reason to write an appeal letter from scratch unless you are writing your very first...
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Denise Wilson | October 28, 2019
Including payer coverage guidelines in your appeal letter templates can increase the efficiency and...
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