CPT Code Validation & Denial Resolution — Coding-Related Claims Recovery

Managed a targeted claims recovery project focused on resolving denials rooted in CPT coding errors, mismatched diagnosis codes, and payer-specific coding compliance issues for a US-based medical practice. Coding-related denials represent one of the most common and preventable sources of revenue loss in any practice, and this engagement addressed that problem systematically. The project involved identifying denied and rejected claims where the primary denial reason was linked to incorrect or unsupported CPT codes, ICD-10 diagnosis mismatches, unbundling issues, or missing modifiers. Each claim was reviewed against payer-specific coding guidelines and CMS standards to determine the appropriate correction pathway — whether resubmission, appeal, or clinical documentation improvement. Claims were prioritised by financial value and filing deadline proximity to ensure maximum recoverable revenue within the appeal window. Corrected claims were resubmitted through Athenahealth with updated CPT codes, supporting modifiers, and accurate diagnosis linkage. Where denials required formal appeals, supporting documentation was compiled and submitted within payer-mandated timelines. The engagement resulted in successful recovery of previously denied claims, a reduction in coding-related denial recurrence, and a documented reference guide of common payer-specific CPT issues delivered to the client for ongoing internal use.

Mã dự án: 40283500