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17 September
2018
By admin2 | 0 comments

Why are So Many Medical Claims Denied?

Medical billing claim denials can significantly slow down cash flow. That is why it’s extremely important to identify the causes of denied claims and prevent them in the future before they occur.

Denials can be hard and soft. Hard denials cannot be corrected; they have to be written-off. Soft denials can be corrected and the claim resubmitted.

Here are the most common errors that can result in a denial of your medical billing claims.

Incomplete or Incorrect information

Even if a single field is left blank or there is an error in it, the claim can get denied. Most denials are a result of incorrect information, such as incorrect name, gender, DOB and insurance ID. Other incorrect provider information may include address, name, contact information. Incorrect insurance provider information often includes wrong policy numbers or addresses.

Duplicate billing

When a claim is submitted for a procedure that has already been paid for or reported, it is considered ‘duplicate billing’. Such bills may make it seem that the patient received two identical services on one day, which is wrong.

Not covered by payer

Your medical billing claim may be denied because the procedure is not covered under a patient’s current benefit plan. This can be avoided by checking insurance eligibility details or by calling the insurer before providing services.

Filing time limit exceeded

Most payers need that your medical claims are submitted within a limited time period. Delays can cause claims to be rejected or denied. Reworking denied or rejected claims for incorrect information or inaccurate coding can cause delays. So, it is important that the coding and billing is done accurately the first time. This is why many practices have now moved to outsourcing their medical coding and billing to responsible, professional medical billing companies that specialize in coding and billing.

To make the most of specialty billing, such as pain management billing and coding and behavioral health billing services, call Emerald Health at 855-650-9906 Today!

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