4 Common Mistakes That Cause Claim Denials

Is your medical practice’s denial rate above 4%? If yes, then its time you started looking closely at your processes. Without you even realizing it, things like input oversights, timing issues and manual errors could be causing denials. Here are some common reasons for your denials. Read on to find out how you can tighten your billing approach and reduce your denial rate at the same time.

1. Illegible claims

Though most payers now accept electronic claims, there may be some who would still use paper and opt for manual submissions. It is not uncommon for printed claims to be illegible and messy. This can generate problems for payers who have to scans such claims into their systems. At your end, you can ensure that your billers pay more attention to such claims and make sure of their readability before sending them to the payers.

2. Vague claims

Coding a claim to the highest level of specificity is the best way to minimize your denials. Make sure that any diagnosis is not vague and is coded to the highest level (maximum number of digits for the code that is being used). For example, if you have a four digit code that requires five numbers to be accepted, make sure that you have included all the five digits. It is also a good idea to provide your billers with appropriate education on coding.

3. Claims with missing information

If there is data missing from your claims, then you could again get a denial. Payers can notice omissions and deny claims based on missing information (the date of onset, the date of the accident or the date of the medical emergency). Make sure that all the required areas on your claim forms are filled. Next, ask your billers to check out the commonly missed fields and rectify the errors, before the claim is sent.

4. Late claims

Claims being denied because of not being filed on time are probably the most frustrating. However, since each payer operates on a different schedule and deadline, it becomes easy to miss filling a claim on time. To overcome this problem, ask your billers to maintain a list of general payer deadlines. Keep tracking and documenting different payer’s receipts of claim submissions.

Put a stop to denials

Carefully inspect each and every denied claim to ensure that it is correct and then build up a denial management system within your practice. This will help you earn the 4% of your money, which would otherwise simply slip away because of denials.

What is the denial rate of your practice? What are some of the steps that you have taken to reduce denials?

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