- Quelin Billing LLC
Top Medical Billing Denials And Smart Tips To Dodge Them
February 24, 2023
No healthcare professional wants to receive denials on their medical billing—it’s both time-consuming and costly. In this article, we’ll review some of the most common billing denials and provide some tips on how to avoid them. Read on to learn more about this critical aspect of healthcare management and get advice on ensuring smooth sailing next time you submit a bill.
Common Denial Causes
A denial can occur for several reasons, but it is usually because the insurance company does not believe that the service was medically necessary or that the documentation was insufficient to support the claim. Either way, it can be a time-consuming and difficult process to get the denial overturned. There are some of the most common causes for denials:
1. Lack of medical necessity: This is by far the most common reason for claim denials. To avoid this, document all services thoroughly and completely, including why they were performed and what diagnostic codes were used.
2. Incorrect coding: Another common reason for denials is using incorrect codes when submitting claims. This can be avoided by using up-to-date coding manuals and cross-checking your codes with those on the payer’s website before submission.
3. Invalid or missing information: One of the most common reasons for claim denial is invalid or missing information. This can include things like an incorrect patient name or date of birth, an invalid insurance policy number, or missing diagnosis codes.
4. Lack of supporting documentation: Insurers often require certain supporting documentation to process a claim. If this documentation is not provided, the claim may be denied.
5. Prior authorization: Some procedures and treatments require prior authorization from the insurer before being covered. If prior authorization is not obtained, the claim may be denied.
By being aware of these common denial causes, you can take some important steps to avoid them and increase your chances of getting claims paid promptly and without hassle.
Tips to Avoid Denials
- Check your documentation. Make sure that you have properly documented the services that you have rendered. This includes double-checking dates, services, and patient information.
- Keep up with coding changes. Make sure that you are using the most current codes for the services that you have rendered. This includes both diagnosis codes and procedure codes
- Submit clean claims. Be sure to submit claims that are free of errors. This includes ensuring that all required fields are completed and that there are no spelling or grammatical errors.
- Follow up on denials promptly. If you receive a denial, follow up as soon as possible to appeal the decision or resubmit the claim with corrected information.
Minimizing Unnecessary Claims and Rejections
It’s no secret that denials are the bane of a medical biller’s existence. They are time-consuming and frustrating, and they can often be avoidable. Check out the most common medical billing denials, along with tips on how to avoid them:
1. Lack of Prior Authorization: This is probably the most common type of denial. Be sure to check with the payer before rendering services to ensure you have the proper authorization.
2. Claim not Filed within a Timely Manner: Another common mistake is failing to file claims within the required timeframe. Be sure to check with the payer for their specific requirements.
3. Invalid/Incomplete Information on Claim Form: This is easy to avoid – simply ensure all information on the claim form is complete and accurate before submitting it.
4. Services Not Covered by Payer: This denial can often be avoided by checking with the payer to confirm coverage for services rendered.
5. Duplicate Claim filed: This happens when a claim is submitted more than once, usually by accident. Keep track of which claims have been submitted and follow up.
Conclusion
Here, we have discussed the top medical billing denials and how to dodge them. Healthcare providers need to stay up-to-date on these issues to avoid costly denials and maximize their revenue potential. Utilizing smart tips such as verifying a patient’s insurance eligibility before providing services, optimizing your coding accuracy claims processes, and properly managing and tracking denied claims will help ensure timely reimbursement of services provided cost-effectively.
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