3 Most Common Causes for Claim Denials

denial management
July 14, 2016

Posted by MedbillingExperts / 0 Comment

Is the claim denial rate at your practice hovering above 4%? If so, it’s time to revamp your process. And for any small practice that doesn’t necessarily have the luxury of resources nor the time to carry out a full-fledge internal assessment, it is beneficial to keep an eye on the most basic mistakes that can lead to denials. This blog talks about some these mistakes in detail-

1. Information is Missing:

Exclusion of even a tiny piece of information, such as patient subscriber number or date of service, can lead to claim denials and cause unnecessary delays in payment. Hence before submitting any claim forms, be sure that you have cross-checked whether every required area is filled in. You can also put in place a list of commonly missed fields in front of every billing representative so that they double-check everything before transmitting the claim to the payer.

2. Codes are Omitted or Assigned Incorrectly:

For a medical claim to be reimbursed by the payer, it must include appropriate code that rightly identifies the diagnosis, as well as the services and procedures performed in that particular case. And to make sure that there are no major hick-ups in the process, it is essential that this process is handled by certified coders who are equipped with the knowledge to code with the highest level of specificity. It can also be beneficial to allow coders to work closely with physicians as this gives them the liberty to access every tiny piece of information directly for the physician and hence eliminate the need to do guesswork regarding this process.

3. Filing Deadline is Not Met:

Healthcare organizations have to adhere to payer deadlines or else chances are that their claim will be denied, even if all of the information on the claim is accurate and complete. Therefore, make sure that you keep a tab on the filing deadline schedule for each payer and submit claims before the cut-off time.

In case you neither have the resources nor the time to effectively handle claim submissions, resubmissions, appeals and denials, consider hiring the services of a proficient third party service provider like us. We are a professional healthcare revenue cycle management company with tons of experience in the field. We leverage this experience to provide superior and cost-effective revenue cycle management solutions. You can use these solutions to –

  • Increase revenues
  • Increase the probability of payment
  • Improve your collection ratio

Contact us now to experience the difference.

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