5 Major Reasons Your Claims Are Getting Denied

Getting your claims denied is a tremendous inconvenience for a practice.
It not only slows things down in the office, but it also delays your payments. It is important to understand why you may be experiencing a build-up of denied claims. As a medical coding company ourselves, we want to help. Here are the top five reasons your claims are getting denied.

#1: You Waited Too Long

One of the most common reasons a claim gets denied is because it gets filed too late. This might seem surprising to some physicians because there is a wide time slot available for claims to be submitted. In fact, in most cases, physicians have around 60-90 days to file a claim to insurance. The clock starts ticking the day the service is made.

Why are these claims not getting filed on time? Organization and amount of paperwork. Claims pile up fast. It can be overwhelming to manage properly. A medical coding company can help you by taking on your claims/coding/billing and significantly reducing your paperwork.

#2: Bad Coding 

Bad coding is a big issue across the board. This couldn’t be truer now than ever due to the implementation of ICD-10. ICD-10 codes can be wrong for a number of reasons. The new codes may not be identical to the old codes used on your most common procedures. Many ICD-10 codes are not written in their entirety. Some codes in ICD-10 mean a completely different procedure than they did in ICD-9. It is important to make sure your codes are not only there, but also full, corresponding, and accurate, or your claims could get denied.

#3: Patient Information

Insurance companies cannot process claim information completely if the patient information is written incorrectly. It’s a small, yet extraordinarily easy mistake many physicians make. Whether their name is misspelled, the birthday is incorrect, or the subscriber number is missing, it all makes it nearly impossible for an insurance company to match the claim to the correct patient.

Imagine how many John Smiths an insurance company has. Every piece of information plays a part in matching a claim to a patient. If they can’t be matched, the transaction cannot be made.

#4: Authorization 

Physicians know that preauthorization has to be made for most insurance plans, yet this is still one of the top reasons claims are denied. Additionally, authorization is only given for a certain amount of time. An insurance company generally gives physicians either a certain number of appointments or a certain number of days before authorization runs out. If care is given following these days, the physician will not get paid for his/her services.

#5: Referrals

This one is difficult and complex. Many insurances companies have adopted a referral process. Meaning, physicians cannot provide a service unless the patient has obtained a referral from their primary care physician. If a service and claim is made before the primary care physician’s referral, the claim will be denied.

Tired of having your claims get denied? Hire a medical coding company! Contact MEREM Healthcare Solutions today.