Getting denied on a medical insurance claim is most common issue in healthcare facilities. This issue waste the physician’s, admin, and patient’s valuable time, but filing an invalid claim can become something of a money-pit as well. Regular causes of denied insurance claims include missing information, billing errors, and questions regarding patient coverage.
In order to avoid billing denials, it’s important to be aware where the biggest margin of error lies. Here we will discuss few reasons for denials.
Missing Information
Leaving even one required field blank can lead to the claim being denied. These type of denials account for 42% of denial write-offs. Examples include:
- Demographic and technical errors—like a missing modifier
- Incorrect plan code
- Missing social security number
Duplicate claim
There are chances to file duplicate claims if you are not following correct process. Duplicate claims are like claims submitted for a single encounter on the same day by the same provider for the same patient for the same service item. Medicare B sees the majority of these claim denials.
Service are adjudicated
This kind of denial occurs when benefits for a certain service are included in the payment of another service or procedure that has already been adjudicated.
Procedure not covered by a payer
Does your billing team check eligibility of patient before date of service? If procedures aren’t covered under a patient’s current benefit plan, they will be denied. These are generally easy to avoid, as going over a patient’s plan or calling their insurer before submitting a claim can head such denials off.
Exceeding the time limit
In a health insurance policy, you are required to apply for reimbursement within a certain period of time. As for emergency admission, the time given is 24 hours after the patient has been admitted, and in other cases, it can change according to the type of policy you have opted for and the treatment being availed by you. If you don’t apply within the time specified, your claim can be rejected.
It can be easily concluded that in order to avoid claim rejection/denials, you should have good RCM process or outsourced billing team in place. If you’re looking for more information on medical billing services or revenue cycle management, please feel free to fill out the simple form and a representative will reach out shortly.
