Top Denial Codes in Medical Billing and Root Causes
Understanding who pays the adjustment—not just the code number—determines your next move.
Suri Eldridge
RCM Letter — Page 2
Infusion RCM
Infusion CPT Code Reference for Billing Teams
Learn which infusion code takes priority and how payers enforce the hierarchy to prevent denials.
Medical Necessity Documentation for Infusion Claim Denials
Payers audit documentation against policy, not clinical reality.
Callum Holloway
More From RCM Letter
Infusion Prior Authorization Denial Overturn Rates by Payer
Only 11.5% of denied infusions are appealed, yet 80.7% of appeals succeed.
Vera Calloway
Medical Documentation Audit Process for Billing Compliance
Incomplete documentation, not fraud, drives most infusion billing denials on audit.
Callum Holloway
CO 97 Denial Code in Infusion Billing
CO-97 denials stem from three different rule systems, and confusing them costs recoverable revenue.
Vera Calloway
COB Sequencing Rules in Infusion Billing Workflows
Permanent COB errors at intake create cascading denials weeks after treatment.
Suri Eldridge
Medicare Reimbursement Rates for Infusion Drugs Under Part B
Six-month payment lags and coding errors silently erode already-thin infusion drug margins.
Callum Holloway
Injection and Infusion Coding Examples for Common Scenarios
How hierarchy and timing designations determine which injection and infusion codes fire.
Suri Eldridge
CMS Documentation Requirements for Infusion Claims
Physician orders must explicitly link drugs to diagnoses and be signed before claim submission.
Callum Holloway
Medicare Fee Schedule Lookup for Infusion Services
Navigate CMS, MAC, and ASP pricing files separately to avoid revenue loss on home infusion claims.
Callum Holloway
CPT 96374 IV Push Reimbursement Rules and Payer Edits
The CMS hierarchy, not the clock, determines which IV push code bills first at a single encounter.
Callum Holloway