Account Recievable

Why do I have to face so many claims denials?

We will use Medicare as an example but this could apply to Medicaid or other third party insurance companies as well.

Medicare claims get denied mainly for the following reasons.

1. Incorrect or missing ICD-9 diagnoses
2. Incorrect or missing CPT-4 modifiers
3. Duplicate claim
4. Additional information needed to process the claim
5. Claim billed amount incorrect
6. Incorrect or missing CPT procedure code
7. Physician's name and/or UPIN missing or incorrect
8. Incorrect or missing place of service code
9. Incorrect or missing quantity of services (Service billed without "quantity" noted, or with multiple quantities indicated in error on claim)
10. Services inappropriately bundled

As you can see, some of the main reasons for claims denials are incorrect/incomplete data entry and incorrect medical coding.

How can I avoid payment delays for healthcare claims?

We help you avoid payment delays from Medicare as well as from other third-party insurance payers by following these steps:

1. We review all claims before submission This cuts down significantly on the error rate. We spend time on reviews at the front end, rather than spend a longer time later to deal with each denial.

2. We maintain a billing and coding claims review log We track the trends for each healthcare service provider, based on the remittance advice from Medicare as well as the EOBs (Explanations of Benefits) from all third-party payers. We monitor and evaluate these trends to find ways to fix the problems causing the denials and rejections for your practice.

3. We do a monthly billing review All the staff involved in the accounts receivable function, ie: those who perform tasks such as data entry, coding and documentation, billing and payment posting, analyzing denials and down codings get together once a month to review:

* All recent insurance carrier newsletters and notices of any billing or coding changes
* Current practice issues that are relevant to the billing function, and
* An analysis of the trends noted from the "claims review log," including how these trends are being handled and the effect on the accounts receivable, measured both in terms of the percentage of error and as "dollars and cents."