Medical billing can be a frustrating process for doctors who wish to provide high-quality care to their patients. One of the big reasons for this frustration comes from claim denials. These denials can pop up for a variety of reasons, and they can make your medical practice less efficient, while also limiting how much reimbursement your facility is receiving. To minimize claim denials, you’ll want to know the source of the problem. Today, we’re going to look at reasons why claim denials happen so you can take measures to prevent them.
Not Getting Pre-Authorization of Services
Typically, insurance companies are going to need pre-authorization of services before treatment is provided to patients. This is especially true when providing surgeries, hospital stays, behavioral therapy, or non-routine therapy.
You need to understand payer requirements before you provide services to patients. You’ll also need to figure out whether or not pre-authorization is needed. If it is, that authorization needs to be acquired before treatment is offered.
When pre-authorization isn’t acquired, claim denials often follow. Your claim could also get denied when referrals are done incorrectly for specialized treatments.
Providing Insurance Companies the Wrong Information
Insurance companies need to be given the right information on patients. One of the most recurring reasons for claim denials is when patient information is inaccurate. It could be anything from wrong birthdate to wrong patient subscriber numbers. Make sure you’re updating patient information every time a patient visits your facility. This helps to keep patient information accurate and current.
Errors in Coding
Claim denials are also known to occur whenever there are medical coding mistakes. This could be a result of using outdated codes, using codes that don’t match up with the provided services, or missing codes entirely. Overcoding and undercoding can also cause denials to pop up.
Submitting Duplicate Medical Claims
You don’t want to submit multiple medical claims for the same therapy or procedure. This can often result in claim rejections. Sometimes, providers will refile claims in order to fix ones that were previously rejected. If, however, the original claim actually got processed correctly, the resubmitted claim will cause a pointless duplicate rejection.
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