Why is my claim being denied? Well, actually there are a few reasons, but we’ll help with a brief list below:
Incorrect or missing patient information. This is as simple as spelling the name Daniela and missing the letter “e”. Danila’s claim won’t be paid. This also has to do with the patient’s demographical and policy information that you provide, as well as the plan and group numbers. This could become a very confusing alphabet soup of denial.
Bad Coding. If there are too many, or too few digits for a code, or if the code is outdated you will receive a denial. And if you have a slip and accidentally swapped a digit you will also be on the receiving end of a denial.
Duplicate charge. When you charge for the same procedure twice, even if it occurs accidentally.
Service not given. This is when a test, or procedure is not performed during the patient’s visit, but was added into the bill for some reason.
Mismatched treatment and diagnosis codes. Your diagnosis code and treatment code should be a match, if they don’t “go together” you will get a denied or rejected claim. If you’re treating for the flu and use a code meant for stitching an eyebrow, you will more than likely be reprocessing the claim.
Upcoding is just as bad as “bad coding”. It’s a red flag when the wrong code is used and results in a more expensive payment from the payer, this could lead to a takeback or recoupment of funds at a later day. In order to avoid this issue you should review your claims prior to submission.
If you’d like to leave the billing and coding to the Gables Medical Billing team our billers are ready to handle all claims submissions, follow-ups, appeals, and payment postings, to get your practice’s revenue cycle functioning efficiently.
Gables Medical Billing has adapted to the ever-changing medical billing environment, modifying and adding to its services to proactively meet the needs of its clients.