The Details of Denials Matter

Karen Zupko
Karen Zupko and Associates, Inc.

In the September 2023 AAOS Now practice management article, “The Details of Denials Matter,” Karen Zupko examines the often-overlooked impact of claim denials on orthopaedic practices and emphasizes the importance of routinely reviewing and sharing denial data with surgeons and staff. The article explains how a lack of transparency around denials breaks the feedback loop and prevents meaningful improvement in billing and documentation practices.

The article highlights common contributors to denials, including incomplete documentation, late filing, registration errors, unbundling issues, and understaffing, noting that denials frequently occur even when coding appears technically correct. By analyzing denial reason codes, practices can identify patterns, pinpoint training gaps, and uncover significant revenue leaks that may otherwise go unnoticed.

This article reinforces that denial management is a shared responsibility between surgeons and staff and demonstrates how regular review of denial reports can lead to fewer appeals, reduced write-offs, and measurable financial improvement for orthopaedic practices.

Read the full article on AAOS Now: