As payer reimbursement policies evolve and scrutiny of outpatient drug administration services intensifies, hospitals are experiencing increasing denials of infusion and injection charges that were coded according to established industry guidance. Many non-governmental payers are applying coding edits, bundling methodologies, and payment policies that differ from AMA and CMS interpretations, creating confusion and financial risk for facilities.

This advanced webcast goes beyond coding fundamentals to address one of today's most pressing revenue integrity challenges: payer denials. Tiffani Bouchard, CCS, will examine real-world denial scenarios, discuss authoritative coding guidance, and explain how facilities can support appeals, payer reconsiderations, and reimbursement discussions. Attendees will learn how to distinguish between legitimate payer edits and denials that may conflict with industry coding guidance.

Why This is Relevant:

Organizations can no longer afford to simply write off denied infusion and injection services. As denials increase and reimbursement pressures mount, coding, HIM, revenue integrity, and revenue cycle professionals must be prepared to defend accurate coding and advocate for appropriate payment. The facilities that understand the rules—and how to apply them in payer disputes—will be best positioned to protect revenue and reduce unnecessary write-offs.

Learning Objectives:

• Analyze common infusion and injection denial patterns and payer rationales
• Identify documentation and coding support needed for appeals and reconsiderations
• Apply authoritative guidance to defend compliant coding decisions
• Understand modifier use and hierarchy application in complex scenarios
• Develop strategies for working with payer contracts, fee schedules, and denial management teams