Category Archives: Uncategorized

Denial$ to Dollars: Virtual Appeal-Writing Workshop

Thursday, April 10th  |  12 PM – 2 PM ET $199/attendee Do you have a [...]

Surprise Billing Handbook: A Guide for Lawyers and Providers

Check out the latest project from Joe Rivet! Both e-books and physical copies are available. [...]

Blue Cross Blue Shield of Michigan will Charge for Appealed Denied Claims

Effective March 1, 2025, BCBSM will begin enforcing a long-standing policy against hospitals that repeatedly [...]

States are Looking to Sanction Payers for Denials

States are closely scrutinizing payers who are frequently denying treatments. The California senate has recently [...]

$100,000 Penalty Against Mental Health Center – Failure to Provide Timely Access to Records

The Office of Civil Rights (OCR) imposed a $100,000 penalty against a California mental health facility, Rio Hondo [...]

Virginia Practice Pays $2M For False Documentation

A hospital in Virginia agreed to pay $2,378,731.06 for submitting claims to Medicaid that were improperly modified by the request of the practice’s employee.  Here [...]

Verification of Benefits – Are Payers Bound by Those Calls?

Verification of Benefits (“VOB”) occurs nearly daily, and the practice relies on the information provided by the [...]

G2211 Can be Reported with Preventive Services

CMS Issued Transmittal 13015 on December 23, 2024, covering expanded reporting of G2211.  CMS allows payment for G2211 when certain [...]

Denial$ to Dollars: Writing a Winning Appeal – Mt. Pleasant, MI

The average denial rate is 18.12% for in-network claims based on data reported from the Health [...]

CMS releases the FY 2023 hospital inpatient prospective payment system final rule

It’s that time of year again. On August 1, 2022, the Centers for Medicare & [...]