Top 7 Medical Billing Denials and How You Can Prevent Them 22 Dec 2023

Top 7 Medical Billing Denials and How You Can Prevent Them

The process of invoicing for medical services can be difficult and unpleasant. As there are several reasons that might result in claims being rejected. In this article, we will discuss the top seven denials that occur in medical billing, including the reasons that they occur and the ways that they can be avoided in the future.

  1. Incorrect coding

Claims that are refused due to inaccurate coding are among the most common grounds for such denials. It is possible for this to happen when the incorrect code is used to describe a service or treatment or when the incorrect code is used to accurately diagnose the patient. For the purpose of preventing improper coding, it is essential to perform a comprehensive evaluation of all codes prior to the submission of a claim. This review should ensure that the codes appropriately reflect the services that were rendered and the diagnosis of the patient.

  1. Missing or incomplete information 

The requirement for additional information is yet another typical cause for claims being rejected. It may include lacking information about the patient or the physician. As well as specifics about the services that were rendered. It is crucial to do a comprehensive evaluation of the claims before submitting them in order to guarantee that all of the required information is included. This will ensure that we include all of the claims.

  1. Lack of prior authorization

¬†The majority of insurance policies provide for the coverage of particular treatments or services through the process of prior authorization. The submission of a claim with previous authorization is required in order for it to be accepted. In order to identify whether or not the patient’s insurance plan requires prior authorization. It is crucial to check with the patient’s insurance plan and get it if it is required.

  1. Non-covered services

It is typical for insurance policies to include limitations or exclusions on the services they will pay for. The majority of the time, claims that are filed for services that are not covered by a patient’s insurance plan are accepted. If you want to avoid this refusal, it is essential to verify with the patient’s insurance plan to find out whether services are covered and to acquire prior authorization if it is required.

  1. Duplicate claims

Occasionally, claims are rejected on the grounds that they are identical to some other claim that has previously been made. When a provider files the same claim more than once or when the patient and the provider file the same claim together, it is denied. For the purpose of avoiding the submission of duplicate claims, it is vital to thoroughly examine all claims before submitting them and to check for duplicates before resubmitting any claims that have been denied.

  1. Timely filing

In the context of insurance policies, the term “timely filing” refers to the deadlines that are in place for the submission of claims. Should a claim be made beyond the deadline, there is a high probability that it will be rejected. It is possible for these dates to range anywhere from thirty days to many months after the service has been rendered, depending on the insurance plan.

It is essential to prevent denials of timely filings in order to maintain the financial health of the medical practice. This is because claims that are denied can result in a loss of revenue as well as an increase in the required amount of administrative work. Immediately following the delivery of the service, it is essential to file claims as soon as feasible. This is something that can be accomplished by utilizing billing procedures that are both efficient and effective, such as electronic claim submission and tracking systems.

In certain instances, providers have the ability to file a request for an extension of the deadline for timely filing if there are exceptional circumstances that prohibit the claim from being submitted on time. Having said that, this is not something that can be relied upon as a standard practice because it is only possible on occasion.

  1. Incorrect patient information

When it comes to medical billing, one of the most prevalent reasons for having claims refused is incorrect patient information. It is possible for this to happen if the information about the patient that is provided does not match the information that is stored with the insurance plan. Errors occurring in the patient’s name, date of birth, or insurance coverage status are all potential causes of this issue.

Before submitting a claim, it is essential to verify all of the patient’s information in order to avoid this kind of denial. It is possible to accomplish this by implementing efficient patient registration procedures and maintaining consistent changes to the patient information contained within the practice’s records.

It is also essential for healthcare practitioners to remain current on any changes that may occur in the insurance coverage status of their patients. This can be achieved through using electronic verification systems for insurance as well as regular patient communication. By maintaining a level of awareness of the insurance coverage of their patients, physicians can assist in ensuring that their claims are sent to the appropriate insurance plan, thereby increasing the likelihood that they will be granted.

It is important to note that denials in medical billing can be a significant cause of irritation and financial burden for both patients and healthcare providers. When it comes to maintaining the financial health of a medical practice, it is necessary to have a solid understanding of the most common reasons for denials and to take measures to prevent them from occurring.

In order to ensure that their claims are processed without any complications and that they are reimbursed for the care they offer, healthcare professionals can help ensure that they follow these steps. Addition, the implementation of a comprehensive medical billing procedure and maintaining a current knowledge of the requirements of insurance plans can assist physicians in avoiding frequent errors and reducing the number of claims that are denied reimbursement. In the end, eliminating denials in medical billing is critically important for ensuring that patients receive the care they require and for sustaining the financial viability of a medical practice.

Effortlessly improve your Denial Management process with Velan

You will have the ability to effortlessly capture the claims, collections, and denials with the help of our cutting-edge technology for denial processing. On top of that, we immediately handle any issues you may be having with denial management. By utilizing our effective and knowledgeable technique for denial management.

The critical denial management process is something that Velan is able to handle with ease thanks to their decades of experience and their staff of dedicated and well-trained professionals. With the help of our sophisticated and automated system. You will be able to streamline and optimize your denial management system in a seamless manner. Allowing you to concentrate on your core competencies and enjoy a healthy revenue cycle.

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals. He can be reached at [email protected]

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