Device and procedure denials, by field.
SCS denials & the WISeR prior-auth
Prior authorization arrived for spinal-cord and nerve stimulators in Original Medicare. The prerequisite pathway that clears the review is the same record that overturns the denial.
Read the guideBPH device denials — UroLift, iTind, Rezum
Prostate size, median-lobe anatomy, and the therapy ladder — the three gates a BPH device claim must clear, plus the 2025 iTind coding change that trips up clean claims.
Read the guideInspire / UAS denials — cleared, not covered
When the FDA label outran the Medicare LCD, upper-airway stimulation claims started denying. The coverage proof — CPAP failure, DISE, the AHI band — that wins the appeal.
Read the guideThe economics of working denials at scale.
The appeal gap at scale
Most denials are never appealed even though four in five are overturned. The economics, where the CARC codes concentrate, and the 2026 regulatory tailwind — for a whole book of clients.
Read the guideThe economics of denials
$25.7B spent adjudicating denials, ~70% overturnable, left on the table. A CFO-ready brief on the KPIs that move, the staffing constraint, and the 2026 drivers.
Read the guideThe appeal no one files
With no appeals desk, good claims get written off. The weekly burden, the overturn gap, and a workflow that fits a small practice with no time to spare.
Read the guideDenials as a profit line
Turn denial work into two revenue lines — service margin on the appeals you run, plus recurring referral commission — through the Merits Partner Program.
Read the guide