Advanced Search

Practice Management Alert

Practice Management:

Don’t Automatically Bill Patients After a Denial

Published on Thu Aug 27, 2026

Reader Question: Our orthopedic practice obtained prior authorization from a patient’s Medicare Advantage (MA) plan for an outpatient knee MRI. The study was performed within the approved period, but the plan denied the claim as not medically necessary because the record did not show six weeks of conservative treatment. May we bill the patient or should we appeal? Illinois Subscriber [...]
Codify by AAPC
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Practice Management Alert

Subscribe to newsletter