In this episode, we break down two commonly misunderstood terms in healthcare coverage: "Statutorily Excluded" and "Not Medically Necessary."

While they may sound similar, these distinctions have major implications for providers, payers, and—most importantly—patients.

We explore how these classifications affect insurance claims, appeal rights, provider obligations, and patient financial responsibility. Whether you're a healthcare administrator, clinician, or just navigating your own care, understanding this difference can help you advocate more effectively within the system.

• ✅ What "statutorily excluded" means under federal healthcare programs like Medicare

• ✅ How "not medically necessary" determinations are made

• ✅ Why the distinction affects patient billing and appeals

• ✅ Key compliance and documentation tips for healthcare providers

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• 1. Statutorily Excluded: Services never covered by law, regardless of medical need (e.g., cosmetic surgery under Medicare).

  2. Not Medically Necessary: Services denied based on clinical judgment or guidelines—even if technically covered.

  3. Appeal Rights: Patients typically cannot appeal statutory exclusions but can appeal denials based on medical necessity.

  4. Documentation Matters: Accurate clinical notes can be the difference between a denied and an approved claim.

  5. Proactive Communication: Providers should notify patients in advance using tools like ABNs (Advance Beneficiary Notices).

     
     

     
     

     Advance Beneficiary Notice (ABN) Guide

     
     

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Whether you’re a coder hunting for the right CPT, a tumor registrar assembling a perfect abstract, or a practice manager double‑checking documentation, that pathology report is gold— if you know how to mine it. In this episode Jennifer breaks down her go‑to process for turning dense, microscopic jargon into clean, billable data that tells the patient’s full story.

In this conversation you’ll learn:

• How to navigate the four must‑read sections of every path report (and why the microscopic description isn’t always the MVP).

• Pro tips for translating diagnostic phrases into precise ICD‑10‑CM codes—without over‑coding malignancy.

• When a single tumor can drive multiple CPTs (and when bundling rules shut that down).

• Common abstracting traps—margin language, laterality gaps, and “NOS” pitfalls—and how to fix them before they hit the claim.

• Simple query templates that get pathologists to clarify size, grade, or margins without slowing the lab down.

Loved the episode? Subscribe, leave a review, and share it with your favorite lab or HIM team.

Stress is inevitable, but burnout doesn’t have to be. In this powerful episode of Practice Perfect, Jennifer and Maya dive into the real reasons behind workplace burnout and what healthcare teams can do about it. From overloaded coders and overwhelmed managers to providers stretched thin, we explore what it takes to create a culture that not only survives—but thrives.

You'll learn:

• How to recognize the early signs of burnout

• Why stress doesn’t always lead to burnout—but poor systems do

• Real-world strategies to build calm into your workflows

• How leadership can set the tone for psychological safety

• Tools your team can use today to reduce chaos and improve morale

April is Stress Awareness Month, making it the perfect time to talk about how your team can reset, recharge, and reclaim productivity without sacrificing well-being.

If you’ve ever felt like your team is stuck in survival mode, this episode is your permission to make a change—and the roadmap to get there.