Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The Fourth-Quarter Denial Sweep: Appeal What You Can Before Deadlines Close
September is the last comfortable month to rescue denials from the first half of the year. Here is how we run a fourth-quarter denial sweep: which remark codes to pull first, how to sort by appeal deadline instead of dollar value, and the write-off rules that keep the list honest.
Denial Root-Cause Analysis vs Denial Follow-Up: Why You Need Both
Follow-up fixes the claim on your screen. Root-cause analysis finds the forty others like it and stops the next forty. Most practices only do the first. Here is how to do the second with a denial log, eight categories and a monthly hour, without a data team.
Denial Prevention for Surgical Practices: Modifiers, Globals and Authorizations
Surgical denials are expensive because each one is large and the fix usually needs the surgeon. Most trace to four causes: a missing or wrong modifier, a visit billed inside a global period, an authorization for a different CPT, and bundling edits nobody checked. Here is how to prevent each, before the claim leaves.
Commercial Appeal Levels: Internal Appeal, External Review and the ERISA Rights
Most practices stop at the payer's provider appeal and write off what it refuses. Two more levels exist, and they belong to the patient: the internal appeal with regulatory deadlines, and an independent external review that binds the plan. We explain each level, the ERISA rights that go with them, and how to use them.
Denial Appeals That Quote the Payer's Own Policy Back to Them: A Working Method
The appeals that get paid are the ones that cite the payer's published policy by name, section and effective date, and show the claim meets it. Here is how we build that appeal in under 30 minutes, where to find the policy, the mapping table that does the work, and which denial codes respond to it.
The Most Common Denial Codes in a Medical Practice and the Fix for Each One
CO-16, CO-97, CO-4, CO-18, CO-29 and their neighbors make up most of what lands on a remittance. We explain what each of the most common denial codes means, the RARC that usually travels with it, where in the practice it started, and the fix that stops it coming back.
The Medicare Five Levels of Appeal Explained: Deadlines, Dollar Limits and Forms
Redetermination, reconsideration, ALJ hearing, Appeals Council and federal court: the Medicare five levels of appeal each have their own deadline, decision clock and paperwork. We walk through each level with the 2026 dollar thresholds, a worked example and the point where most practices should stop.
Building a Denial Work Queue That Pays: Sort by Dollars, Deadline and Fix Type
Most billing teams work denials oldest first, which is how $14 balances get touched while $2,400 authorization denials pass their appeal deadline. Here is how we build a denial work queue sorted by expected payment, days to deadline and fix type, with the fields, the scoring and the numbers to watch.
CO-50 Medical Necessity Denials: How to Appeal Them and Stop the Next One
CO-50 is the payer saying the service was not medically necessary, and in our experience most of them are really diagnosis coding or coverage policy problems. Here is how to read the remark codes, find the LCD or payer policy behind the denial, write the appeal and build the front-end check that prevents the repeat.
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