Order-of-Insurance Denials Costs Money, Damages Patient Experience

When it comes to payment denials, some of the most common and potentially damaging involve Claim Adjustment Reason Code (CARC) 22, or order-of-insurance coverage problems. CARC 22 denials reduce cash flow, trigger unnecessary patient invoicing, and may undermine customer goodwill and harm the hospital’s overall patient experience and brand.

CMS Imposes Prior Authorization for Specified Outpatient Procedures

Medicare recently finalized a plan that will require hospitals to obtain prior authorization before performing certain outpatient procedures. Understanding these changes will be critical to avoid unnecessary denials beginning on July 1, 2020.