TOP 10 REASONS WHY HEALTHCARE CLAIMS ARE DENIED

The medical industry faces a very big threat as denials. Usually claims are denied because there is some important information missing but the highest risks are medical people should find what is the missing information and work on it to avoid rejection. Only some of the medical practitioners try to correct the denials and apply for the next time and many don’t do it. The top 10 most happening denials are listed below and even anybody can check with it to clear off your denials.

ICD issues

ICD-10 coding is presently implemented and there are lots of chances to change the coding. The patient may suffered from asthma which will have a different set of codes. When just one number in codes goes wrong there are chances for ICD issues. When denial happens, check with ICD codes.

CPT modifiers

The CPT modifiers are most important just like ICD. The CPT determines the correct payments for specific disorders. So, the codes for CPT must be right enough to get proper reimbursements within a short span of time.

More information

There are chances for the payer to ask for more information about the medical bills. When a patient goes heart surgery, simply heart surgery is not enough for the health care industry to process with reimbursements. Every detail of the surgery and why the surgery happened should be specified to get proper reimbursements.

Duplicate claims

When the same provider is submitting the patient’s details more than once on the same date with same information then there are chances to get denials.

Incorrect bill amounts

The bill amounts should go matching with CPT codes. When there are incorrect bill amounts apart from taxes then it might become of the reason to undergo denials for any kind of reimbursements. It is very important for a medical industry to stay transparent when it comes to reimbursements area.

Incorrect mention of UPIN

Every physician has got a UPIN and it has to be mentioned properly in claims. When the claims don’t have proper information about the physician name or details about him or her then there are chances to get denials. Make sure that there are no such issues with name of the physician.

Proper service codes

Services codes are necessary to identify where the provider has given the treatments. When improper service codes are given in your claims, then there are chances for getting issues in claims which will lead to denials.

Duration of claim

The claim should be filed within 90 days and when you are filing beyond the 90 day period then there are chances for getting denials. Don’t forget the proverb “Early bird catches the claim”.

Change of insurance plan

The change of insurance plan is one of the main reasons for denials. Try to stick on with the insurance plan and try to apply for that claim.

Out-of-State insurance plans

They are also one among the reasons to get claims. Make sure you are picking the right plan which can be applicable in all parts.

These are the happening 10 reasons and try to avoid it to get reimbursements in faster pace.