Denied claims can be a major issue for medical practices as they negatively impact cashflow cycles and also increase your overhead costs as it takes a lot of employee time to resubmit the claims again. If practices know the real reasons behind denied claims they can easily avoid them and improve their revenue stream and keep financial issues at bay. Financial success can be guaranteed if unexpected claims denial can be reduced.
Top 7 causes for denied claims
- Reason 1 When the correct payer hasn’t been identified by the claim that is accountable for services. Practices can overcome this issue by looking at patient access and patient registration.
- Reason 2 Sometimes the patient is not eligible for the health service as their health plan coverage has come to an end, and the patient doesn’t have any evidence of a new insurance plan.
- Reason 3 Claims can also be denied when the benefit has surpassed the limit. For example, the allowed number of physical therapy visits have been already been covered by the health plan within the year.
- Reason 4 The information is incomplete such as an EPO claim might be missing value codes 48 and 49. Practices can overcome this reason by checking Patient Financial Services as sometimes the missing codes are due to improper file maintenance.
- Reason 5 Claims can also be denied when the diagnosis reported did not meet the LCD/NCD rules and guidelines. Diagnosis-related claims denials can be corrected by educating healthcare providers and you can look for Reason Code 50.
- Reason 6 A coding or data error can result in denied claims as there are mismatched totals or mutually exclusive codes.
- Reason 7 If you are a specialist then your patients must get referrals from their primary care physician before they plan to visit your office. When referrals are not documented in your patients’ records then you may experience unexpected denied claims.
Conclusion –
Practices can steer clear from the issue of denied claims by knowing the root causes for the financial stressors. Denied claims can be a horrible nightmare for many healthcare organizations and that’s why they have deployed a Billing Services EMR software solution that digitizes and automates the claims filing process. Alerts of any claim errors are sent before they go out to the payer which cuts down the problem of denied claims. The claims acceptance rate improves and your practice can experience financial success.
