Getting paid as a doctor should be straightforward, right? Provide a service, submit a claim, and receive payment. It sounds simple enough, but a lot could go wrong with the process. The American Medical Association’s most recent study found that major payers return to up to 29% of claims with $0 payment. This happens most commonly because the patient is responsible for the balance. It also happens 7% of the time because of claim edits and 5% of the time because of other denials. But what kinds of things can go wrong?
LINKS:
____________________________________________
[ Ссылка ]
____________________________________________
Each diagnosis must follow the ICD-10-CM standard. In a nutshell, a doctor’s diagnosis becomes a code of letters and numbers for insurance companies to understand what happened in the exam room. The code must have the maximum number of digits to use it. Otherwise, there will be some sort of error. An insurance company may deny a claim because of a coding error. Maybe it was incorrect, incomplete, or inadequate. If you receive a denial within this reason category, in most cases the payer will send it back to you with code CO 11. Luckily for you, this is an easy fix! Just resubmit the claim with the correct coding information.
You might face a denied claim because there was some sort of information missing on the claim. Maybe you mistyped the patient’s last name or you forgot to enter their address. Most of the time, this kind of denial happens because you are missing the date of the accident, medical emergency, or onset. This denial reason also usually follows a CO 11 code from the payer.
Maybe you filled out all of the different sections of the medical claim you just submitted. Therefore, there’s zero missing information. All good to go right? Wrong. If you misspelled the patient’s name, mistyped their date of birth, or clicked on the wrong gender, your claim will get denied. Some things you should double-check prior to claim submission to catch this error are… Policy number… Needing a group number… Any exclusions… Proper diagnosis code… and Typos in patient information. The standard denial code that comes alongside inaccurate patient information is CO 16.
► Reach out to Etactics @ [ Ссылка ]
►Subscribe: [ Ссылка ] to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: [ Ссылка ]
►Find us on Facebook: [ Ссылка ]
#claimdenials #revenuecycle #medicalbilling
