Why Claims Get Denied: Coding Complexities Documentation, Modifiers & Rules - CCO Academy

Описание: If you’ve ever wondered why claims get denied even when the service was performed, this video breaks it down: documentation, modifiers, medical necessity, bundling rules, and payer-specific policies are what make—or break—reimbursement.

In this video, we cover:

Why documentation is the foundation (“If it’s not documented, it wasn’t done.”)
-The most common documentation gaps (laterality, severity, timing, acute vs chronic)
-Modifier fundamentals and how modifiers change the “story” of the claim
-The biggest audit triggers: modifier 25 and modifier 59
-How medical necessity drives payment (and why “because we can” is not a rationale)
-Bundling vs unbundling and why NCCI edits matter
-Why payer rules vary (Medicare vs Medicaid vs Commercial plans)
-Emerging trends: AI scribes, telehealth shifts, SDOH, and why CDI is growing fast

This is a must-watch if you code E/M + procedures, work denials, support provider documentation, or want to level up your compliance mindset.

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