Denial and Appeal Services

Correct wrongful denials and underpayments through optimized and aggressive appeal services.

Robust Denial Management is Essential in Healthcare

C.F.R. provides assessment and appeals for coding and DRG revisions whether by the CMS Recovery Audit process or by private insurances. Our coding and DRG experts are skilled with years of experience in assessing and appealing DRG revisions.

Our services include assessment and appeals for medical necessity denials of inpatient stays. C.F.R. has an extensive record of success in appealing RAC medical necessity denials with over 90% of cases won on appeal.

C.F.R. provides denial assessment, problem identification and management and resolution services for denials of outpatient and professional services.

Leading Coding Expertise for DRG Revisions

Our Coding and Appeal Divisions include industry leading experts with experience in clinical validity, ICD 10 CM/PCS fluency, and documentation improvement.

Solving Medical Necessity

Commercial screening tools for level of care assignments are only the beginning.  The complexity of clinical medicine is not simplified to narrow screening criteria.  Maximize your denial overturn rate with a robust, clinician driven, appeals process.

Improve Denial Management Success.

With our decades of experience in Denial Management across all sizes of organizations, we have the solution for you.