Rectifying Claim Denials arising from New Medical Codes

by | Last updated Jun 19, 2023 | Published on Jun 7, 2013 | Medical Coding

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Claim denials happen if your medical coding is not done properly and there are coding errors. New medical codes are released by the American Medical Association (AMA) every year and the chances of errors are high when these are reported, thereby increasing denials. It is important that you monitor claim denials. This helps you find out if an insurer processing the codes correctly or if the new codes have not been entered in your practice management system. Some claims can be fixed for resubmission, but not all. The following tips can help you can minimize claim denial:

  • Regularly update your fee schedules that must contain payment rates for new and revised medical codes.
  • Healthcare providers and medical coders must be educated on the new and revised medical codes. Proper documentation is required to support these codes.
  • Update your encounter forms or super bills and systems when new codes are issued. These codes must be stored and used for claim submission.
  • Revised CPT coding guidelines are reviewed for identifying any changes that are shown in green text in the CPT code book.
  • Review the CMS Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) and also the payment polices of private insurance firms. The details can be found on their official websites. Reviewing these policies helps identify the diagnoses that support medical necessity, clarify code use and take care of documentation requirements.

To minimize claim denials and getting proper reimbursements, get professional help. Outsource your coding and billing tasks to an established medical billing and coding company. With teams of qualified and experienced medical coders and medical billing specialists, the right firm can provide you customized medical billing and coding services.

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    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

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