Denials & A/R
Before you rework a denied claim
A denial queue becomes useful when it explains what the payer said, which decision is needed and who will act next.
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Practical reading for the work between patient care and payment. Explore specialty workflows, payer follow-up and the decisions that keep a practice moving.
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Denials & A/R
Turn an aging report into a weekly work plan
An aging report is a starting point for investigation.
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Enrollment & authorization
A provider enrollment project that reaches billing
A provider enrollment project is unfinished operationally when its outcome never reaches scheduling and billing.
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Practice operations
Prepare evidence for a useful billing review
A billing review should answer a defined question with reproducible evidence.
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Specialty billing
A daily billing checklist for primary care
Primary care billing depends on small, repeated handoffs between reception, clinicians and billing.
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Specialty billing
Keep primary care coverage updates connected to billing
Coverage information can change between primary care visits.
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Specialty billing
Preventive and problem visits: build a better review handoff
A visit described as “annual” can still create documentation and billing questions.
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Specialty billing
Find missing primary care encounters before claims leave
Encounter reconciliation asks whether each relevant visit reached the appropriate billing stage.
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Specialty billing
An internal medicine billing workflow from visit to follow-up
Internal medicine practices manage recurring visits, ongoing relationships and frequent administrative changes.
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Specialty billing
Investigate recurring internal medicine denials
Repeated internal medicine denials need two kinds of work: a sound decision on each affected item and a separate investigation into the process that allows the issue to repeat.
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Specialty billing
A month-end billing review for internal medicine
Month-end billing review is most useful when the practice can reconcile the numbers to work completed and decisions still pending.
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Care coordination
CCM readiness: separate administrative tasks from billable care
A chronic care management program needs clear clinical ownership and reliable administrative support.
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Care coordination
Organize the monthly CCM record review
A monthly CCM review should make missing records and unanswered questions visible before an authorized billing decision.
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Specialty billing
Behavioral health billing starts with provider and visit checks
Behavioral health billing questions often require a precise view of the provider, service and visit record.
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Specialty billing
Cardiology billing: map the service and responsible organization
Cardiology workflows can involve office visits, diagnostic work and coordination across organizations.
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Useful work starts with a clear next action
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Talk through your practice’s workflow.
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