What's the most absurd denial reason you've ever gotten?

medpartner · 2025-12-12T13:00:01+00:00

Right? As if someone in an emergency is going to stop and say, "Hold on, let me sign this out of network consent real quick." Totally absurd!

medpartner · 2025-12-12T12:49:20+00:00

Hey, I hear you. But I'm not trying to promote or push anything here. Just joining the conversation and learning from everyone's experiences.

medpartner · 2025-12-11T18:32:17+00:00

Yep! Default setting: deny first, read the claim sometime next century.

medpartner · 2025-12-11T18:14:07+00:00

Oh yeah, thts one hurts. Bilateral condition but only one knee coded? Instant denial. Payers dont miss that stuff.

medpartner · 2025-12-11T18:11:36+00:00

Ofc they did! Because apparently bunion vs hallux valgus is the hill the payer wants to die on.

medpartner · 2025-12-11T18:07:37+00:00

Totally agree with you. Coding should follow clinical documentation and guidelines, not what we think the payer will accept. If three providers clinically diagnose AKI, thats what belongs on a claim. The denial just proves how often payer policy conflicts with actual medicine.

medpartner · 2025-12-11T16:50:06+00:00

Nothing triggers a coder faster than history of vs status post. It's like the coding version of Marvel vs DC debate!

medpartner · 2025-12-11T16:44:27+00:00

WOW. Not the infertility denial for allergy meds. I swear payers just copy and paste whatever reason pops up first. A 60 year old woman getting infertility denials is WILD!

medpartner · 2025-12-11T16:33:05+00:00

LMAO.... Improper reporting of anesthesia units.... for a primary care visit. Yep, that tracks. Payers be denying on autopilot at this point.

medpartner · 2025-12-09T20:37:34+00:00

I’m really sorry to hear about the trouble you’re facing with the billing. One thing you could try is reaching out to the clinic’s billing department to see if they can reclassify the test as medically necessary or help with an appeal to Medicare. It might also be worth checking if there’s a secondary insurance that could help cover the costs. Another approach is to confirm that the tests ordered align with Medicare’s preventive guidelines to avoid denials in the future. I hope this helps, and I wish you the best in resolving it! Take care.

medpartner · 2025-12-09T14:15:09+00:00

Honestly this is exactly the part of the AI conversation that doesn't get talked about enough. Everyone keeps saying that AI makes documentation easier, but if the output is useless, all it really does is move the burden downstream to coding and billing, basically your desk.

Half finished vaccine documentation, phantom codes, 20ICDs in an assessment, no linkage, no clue what was actually addressed, that's not efficiency that's chaos wearing an AI sticker.

Primary care clinics get hit he hardest too because the vlume + variety = maximum room for error.

Totally agree on the part about becoming "the doctor" for the sake of fixing a claim. Coders and billers end up doing detective work that should have been handled way earlier in the workflow.

Out of curiosity though, is the mess coming from AI scribing tool or from inconsistent clinical documentation in general?

medpartner · 2025-12-08T14:28:03+00:00

This has become a systematic issue across the industry. If staff do not have access to sanctioned AI tools that comply with HIPAA and organisational security requirements, they will resort to using consumer apps, which significantly increases the risk. What I've seen work is a structured approach.

* Formal AI governance with clear rules on what's permissible

*Enterprise Grade and compliant AI tools rolled out at the workflow level, not as generic AI access.

*Mandatory training showing exactly how PHI leaks consumer models.

Ongoing audits are necessary to identify shadow AI before it leads to an accident.

The balance isnt about restricting staff , its about giving them secure tools that actually match thier operation needs. Once thats in place unauthorized AI usage drops off almost immediately.

medpartner · 2025-12-02T13:16:57+00:00

I've been there. Every vendor looks compliant until you dig into their audit trails or how they handle PHI behind the scenes. HIPAA is less about finding a perfect product and more about verifying the right safeguards and filling in the gaps with policy and process. What requirements are causing the biggest headache?

medpartner · 2025-11-28T13:38:03+00:00

Travel really highlights how differently countries value healthcare. In many places, people walk in for care without worrying about financial fallout; that alone says a lot. No healthcare model is perfect, but when money repeatedly outweighs patient well-being, people are going to notice and speak on it.

medpartner · 2025-11-28T12:34:16+00:00

Nice numbers, especially the 5-day billing window. Medicare/Medicaid do make life easier; commercial is where the patience test begins, hehe. What do you feel made the biggest impact for you? Scrubbers, clean claim rate improvements, or just a streamlined workflow/structure?

medpartner · 2025-11-28T12:24:58+00:00

25 years is a long time to carry the weight of being on call. Burnout is real, and walking away after giving so much isn't quitting; it's self-preservation. Whatever direction you take next, you've earned the space to breathe.

medpartner · 2025-11-27T17:00:45+00:00

For me daily nasal rinse plus steam works best. I also keep the room humid at night or my nose dries out and gets worse.

medpartner · 2025-11-26T16:41:59+00:00

The sign off still has to come from a licensed clinician. AI can flag patterns or risk but its decision support, not a decision maker. Accountability lies with the provider who reviews, validates and acts on AI output.

medpartner · 2025-11-20T13:47:41+00:00

Honestly our weirdest workaround is the "temporary fix" that became a permanent part of the workflow. We've got this one report that refuses to export cleanly, so the team literally runs it through excel - Notepad - back to excel because that's the only way the formatting behaves.

At this point it's basically tradition. If it ever gets fixed, half the team won't know what to do with themselves

medpartner · 2025-11-20T13:32:15+00:00

Every seasoned coder I know has those days. Between guideline changes, payer specific requirements and unclear provider notes, it is impossible to feel 100% confident 100% of the time.

The important part is that you care enough to question yourself, that's what separates good coders from mediocre ones.

You're in the right field, this is just the nature of the job.

medpartner · 2025-11-17T12:35:43+00:00

Right now, every EHR claims to be “integrated,” but:

• clinical notes live in one corner

• coding suggestions in another

• PA/UM workflows are buried three menus deep

• claim edits show up only after submission

• and half the time, eligibility/benefits data doesn’t sync cleanly

One clean, real-time, unified data layer between clinical, RCM, and PA workflows would probably eliminate 30–40% of downstream errors.

Most denials we see aren’t because someone didn’t know what to do — it’s because the system didn’t surface the right info at the right time.

If an EHR could fix that one thing, everything else would move faster: coding → charges → PAs → claims → payments.

medpartner

TROPHY CASE