If a medical office or physician is experiencing many medical billing denials, it will create a lot of stress. It will have a direct impact on the revenue of the provider. This is why most healthcare organizations pay special attention to denial management.
Basic Denials in Medical Billing and what is Denial Management
Medical billing denials slow down the efficiency and operations of the ED. If it is happening in the long run, it will be a cause for serious revenue leakages. By practicing denial management, you can:
- Identify the root cause of denied medical claims.
- Determine how to lower the rate of denied claims.
- Implement strategies to encourage error-free claims and increase revenue.
Now, let’s take a quick look at basic denials in medical billing that you should know:
Missing Information
If even one necessary field is left blank accidentally, you are calling for a denial. It includes plan codes, security numbers, addresses, modifiers, etc. The percentage of denial write-offs and healthcare billing denials are 42% and 60%, respectively, because of blank fields.
Service That Insurer Doesn’t Cover
It happens when medical billing staff does not talk to the insurer of their patient to ensure that services and procedures they perform come under the benefit plan. Therefore, it is essential to ensure that they check and confirm the insurance plan of the patient.
Duplicate Service or Claim
Duplicate claims are also a big cause of denials in medical billing. It happens when the claims you submit have the identical beneficiary, healthcare provider, service date, and service performed. Therefore, it is essential to ensure that there is no duplicate service or claim.
Already Adjudicated Service
It is another common cause for denial claims in medical billing. Medical billing staff needs to make sure that there is no adjudicated service.
Expired Filing Limit
Insurance companies always have a specific time frame to submit claims. If you don’t submit claims before that time frame, it will result in a denied claim.
Knowing the basic denials in medical billing will assist you to plan and implement a perfect strategy to prevent denied claims.
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