By Cyber Sense Billing Team · Published · Updated
Start at the front desk
Many denials trace back to registration: wrong subscriber ID, inactive coverage, or the wrong payer order. Verifying eligibility before each visit prevents these at the source.
Check authorization requirements
Imaging, procedures, infusions and therapy visits often need prior authorization. Track approved units and dates so services don't exceed what was approved.
Review coding before submission
Common coding denials include:
- Missing or incorrect modifiers
- Unspecified ICD-10-CM codes
- Services bundled under NCCI edits
- E/M levels unsupported by documentation
Track denials by reason
Group denials by CARC code, payer and provider each month. The pattern tells you which upstream step to fix.
Appeal within deadlines
Each payer sets its own appeal window. Work denials promptly and keep proof of timely filing.
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This article is general information, not legal or coding advice. Always check current CPT®, ICD-10-CM, CMS and payer guidance. Questions? Contact us.