What decides whether you get paid.
The money mechanics a solo practice rarely gets taught — how Medicare prices a code, what a prior-auth denial does to the claim behind it, and the plan type that changes which rules apply.
Medicare Fee Schedule
How RVUs, the conversion factor, and geographic adjustments set what Medicare actually pays for a code.
Read the guidePRIOR AUTHPrior Authorization
Federal timelines, peer-to-peer review rights, and what a PA denial does to the claim downstream.
Read the guidePLAN TYPEERISA Plans
Why self-funded employer plans answer to federal law, and what that changes for your appeals.
Read the guideThe codes behind your denials.
Each carries its own argument and an honest read on the odds — start with the one on the EOB.
Not deemed a medical necessity.
Appeal strategyPrior authorization absent.
Appeal strategyThis diagnosis is not covered.
Appeal strategyInformation doesn't support this many services.
Appeal strategyCharge exceeds the allowed amount.
Appeal strategyNot certified or eligible for this service.
Appeal strategyWhen the next denial lands.
Upload a denied EOB and Merits drafts the appeal — the clinical argument and the coverage criteria that govern your plan type — cited and ready for your signature in about a minute.