Mastering Inpatient Denials: Strategies to Protect Revenue and Improve Compliance

By: Briauna Driggers

Inpatient denials can disrupt your practice’s revenue cycle, create administrative burdens, and lead to compliance risks. Our latest webinar tackled these challenges head-on, equipping you with strategies to overcome denials in areas ranging from coding complexities to documentation requirements.

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The Importance of Accurate POS Coding

​One major issue discussed in the webinar was the importance of accurate Place of Service (POS) coding. POS coding must match the patient’s care status, whether they are transitioning from outpatient to inpatient or remaining under observation. Our experts emphasized the need to stay on top of state and payer rules for POS adjustments, as these can vary widely and have a direct impact on claim acceptance.

Payer-Specific Rules: Navigating Non-Covered Services and Rolling Admission Limits

​Payers often impose limits on certain services, which can result in denials if overlooked. Many payers enforce a “rolling 30-day” rule, allowing only one admission billing within a 30-day period. Our panel outlined strategies to manage these limitations and emphasized the need to understand each payer’s unique rules on non-covered services and admission billing restrictions.

Decoding Consultation Codes for Reduced Denials

​Consultation codes remain a complex area, with many payers now requiring these services to be billed under alternative E/M codes. The webinar highlighted how setting clear internal policies and ensuring strong communication between providers, coders, and billers can prevent consultation code-related denials and ensure consistent claim accuracy.

Modifier Mastery: Handling Bundled Services

Modifiers like 24, 25, and 57 play a critical role in avoiding bundled service denials, especially during global periods or when multiple procedures occur on the same day. Modifier 24 is essential for services unrelated to a global surgical procedure, while Modifier 25 allows for separately identifiable E/M services on the same day as a minor procedure. The session broke down these modifiers and shared actionable tips for consistent, compliant use.

Tackling Critical Care and E/M Codes

​Billing for critical care services can lead to denials when multiple providers submit time-based codes for the same patient. The experts discussed how consolidating critical care billing under a single provider can reduce denials and outlined the documentation necessary when billing both critical care and E/M services on the same day.

Get the Full Insights

​Missed the live session? Don’t worry! The full webinar recording is still available and packed with detailed guidance on minimizing inpatient denials. Download the webinar here to gain access to these valuable insights and ensure your claims are approved the first time.

Dealing with surgical procedure and global period denials? Check out part one of this series.