FTLORC Live Denials Q&A! 03/10/26

FTLORC Live Denials Q&A! 03/10/26 *Please note, the connection on the call dropped at the end, which is why there is a sudden cut-off. Vanessa Moldovan hosts a live community Q&A on denials and reimbursement, emphasizing end-to-end operational knowledge and root-cause fixes rather than siloed work. Nicolette shares a Medicare claim-rejection issue traced to offshore staff creating duplicate Medicare payer records with incorrect addresses, prompting new claim-entry guidelines. Participants discuss appeal effectiveness over sheer volume and trends in California denials, including Blue Shield requests for additional information and heightened scrutiny of 99213/99214 tied to fraud concerns and diagnosis ordering. Perva describes Medicare wellness/preventive denials for newly eligible members that required rebilling with 99214 instead of a G code and asks about Medicare crossover failures tied to patients updating secondary coverage with Medicare. Guadalupe details out-of-network underpayments driven by third-party pricing vendors like MultiPlan/Data iSight, ERISA-based appeal strategies, obtaining pricing in writing, NCCI/edit disputes, and escalation up to payer leadership. The group also covers documentation precision for time-based behavioral health codes and an orthopedic prior-authorization scenario where an authorized arthroscopy code was denied after a meniscectomy was coded, raising compliance and documentation questions. 00:00 Live Q&A Kickoff 00:55 Medicare Address Setup Errors 02:12 Root Cause Denial Fixes 04:46 99213 Denial Surge 06:57 Wellness Visit Coding Timing 09:09 Medicare Crossover Issues 10:50 Out of Network Underpayments 13:00 ERISA Appeals Strategy 16:40 Bundling and NCCI Disputes 21:05 Escalating to the CEO 24:53 Community Shoutouts and Teaching 26:28 Out Of Network Gap 28:03 Manual And LLM Help 29:05 Automation And Pricing Games 30:39 Multiplan Data Eyesight 32:32 Specialties And New Markets 33:36 Behavioral Health Denials 34:47 Time Based Documentation 36:42 Ortho Prior Auth Denial 42:15 Coding Billing Compliance 46:16 Wrap Up And Thanks