Medical billing and coding can get quite complex, and because of how difficult the process can be, denials can sometimes pop up, but what causes those denials? The processes for billing and coding will depend on your insurer, patient, and procedure as well. Fortunately, you can reduce claim denials significantly by simply knowing the common causes for them to pop up. Here are common reasons that claim denials come up during medical billing and coding.
Coding Isn’t as Specific as It Needs to Be
All diagnoses you have need to get coded to whatever the highest level is for that particular code. Coding needs to be done as specifically as possible so that all of the important details are captured for later, which can impact how patients get treated.
Claims are Missing Information
In the field of medical billing, you can’t submit claims without having all of the needed information. Common pieces of information that get omitted from medical bills include the date when the medical emergency happened, and the date when the accident took place.
Before you submit a medical claim, you should check it thoroughly to be sure that your claim isn’t missing any information, and that all necessary documentation is included.
Claim Isn’t Filed Punctually
Even if your medical claims are submitted correctly, you can still run into problems if they don’t get submitted in a timely manner. Keep in mind that claims get denied if they are received after the end date, even if they get sent out before that end date.
You also need to understand that certain supporting documents will be required if you want to get reimbursed for any services that got denied.
Wrong Patient Identifier Information
There are many manners in which a patient’s information can be incorrectly documented. Documents could have the wrong patient name. The date of birth might be off. Perhaps the patient’s sex is inaccurate. There could even be the wrong payer information, or the policy number could be invalid. Making sure all of this information is correct and valid does wonders to keep claim denials to a minimum.
If your biller or coder doesn’t input the right codes, or you have an out-of-date codebook, your claims will likely get denied. You also need to have enough documentation to justify payment for whatever services you provided. Not providing enough information will result in you not getting payment for the services that you provided for your clients.
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