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A New Frontier of ProFee Denials Remediation

This presentation will include three main sections:

During part one, the presenter will discuss an overview of professional fee coding and denials to give attendees a basic understanding for the rest of the presentation. They will include definitions and references that learners can utilize in their professional capacity.

During part two, the presenter will exhibit real examples of common issues/denials for professional fee, utilizing references like the Medicare Physician Fee Schedule to exhibit a denials remediation process for these common issues.

During part 3, the presenter will utilize a case study to exhibit common challenges faced in starting a successful denials remediation program in a newly acquired large physician group, and strategies to overcome these challenges. Data will also be presented on the success of these strategies during the case study.

Learner Outcomes

After completing this session, attendees will:

• Be able to identify the unique challenges of professional fee denials during a physician group acquisition, comparing and contrasting the denials one would see for the facility reimbursement.
• Understand professional fee coding guidelines, common professional fee denials challenges, and references to utilize for a successful denials remediation program.
• Learn additional strategies and references to overcome these unique challenges.


Vanessa Youmans, MA, RHIA, CCS, CPC
YES HIM Consulting, Inc. Largo, FL
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