Understanding the reasons why medical claims get denied by insurers can help limit the number of denials your medical office reimbursements. The only way to prevent them is to be aware of what they are. You might be aware of common claim denial reasons. Here are some common reason why medical billing claims get rejected.
Delay to file claim
Most insurance companies allow 60 to 90 days from the time of service to file a claim. When claims are filed too long after the date of service, they are rejected.
If the bill was submitted to EDS before it was submitted to the patient’s private insurance company.
Get all insurance information from the patient even if that insurance will not pay for services provided. Submit the claim to the Primary carrier then send in a bill with the attached Explanation of Benefits (EOB) to EDS.
Missing Correct Codes
Diagnostic code (ICD-10 code) and CPT code are missing, incomplete, invalid, or do not correspond to the treatment rendered by the physician.Â
The Insurance Company Misplaced the Claim, and then the Claim Expired
Irrespective of how it was misplaced, if a misplaced claim doesn’t enter it into the insurance company’s system before the deadline, the claim will be denied.Â
Pre-authorization
Pre-authorization is an essential for many insurance plans. Providing services without the proper authorization will cause the claim to be rejected.
Two Services in One Day
If a patient is authorized for 12 sessions of therapy and if you provide two sessions in one day then you won’t get paid for the second session. Physicians who have group therapy, psychological testing, or medication reviews beware sometimes these services also come under the one service per day policy.
The Provider is not credentialed with the Insurance Company
If a physician attend a patient and he isn’t a credentialed with the patient’s insurance company, the claim will be denied? If a physician was working for a larger clinic, he (or she) might think that he is a panelled provider, when really he was working under his old employer’s contract with the insurance company.
Wrong Location
When a counsellor is panelled with an insurance company, they list one (or multiple) practice addresses. It is important to make sure that providers have all the places they serve patients registered with all the insurance companies they work with. Provide services at an unregistered location, and the claim could be denied.
To reduce your claims rejections and improve reimbursement call us today at 302-261-9187 or email us at info@medisysdata.com to know more about how to avoid such issues to process the payment faster.
