Nothing can be more frustrating for a medical practice than claim denial. Knowing why claims are denied is important to prevent it from happening.
- Incorrect demographic information: The patient’s name is spelled incorrectly, the subscriber number or referral number is invalid or missing, the date of birth provided does not match the one in the records – these are all examples of erroneous policy holder data.
- Insurance coverage is non-effective or terminated: The patient’s insurance coverage may have expired or it could have been withdrawn by the insurer due to some reason.
- Diagnosis does not support procedure coverage: This means that the claim was submitted for a procedure which was not medically necessary according to the physician’s diagnosis.
- Incorrect codes: Each service for which claims are made should have the right codes.
- The benefit is not covered: It is important to make sure that a claim is submitted for a benefit which is mentioned in the patient’s insurance policy.
- No prior authorization was obtained: Insurers insist that prior authorization must be obtained from them before services are rendered to the patient. Unless the authorization number is provided, many companies refuse to pay. Getting the authorization number is part of the insurance verification process.
- Filing deadline is not met: Claims will be denied if they are not filed within the stipulated dated.
Keeping track of claims and preventing denials can prove difficult and time-consuming for a busy medical practice. Opting for physician billing services from a competent medical billing company is the solution. A whole array of services are provided, from verification, authorizations and patient registration to medical coding, charge capture, payment posting, EOB management, AR management, and more. Denied claims are appealed and followed up on to ensure that physicians obtain maximum reimbursement. With expert staff on each task, a reliable physician billing service provider can help medical practices reduce cost and optimize revenue.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.