10 tasteless Reasons Why medical Claims were being Denied and your activity Plan

Health Insurance Card - 10 tasteless Reasons Why medical Claims were being Denied and your activity Plan

Hi friends. Yesterday, I learned all about Health Insurance Card - 10 tasteless Reasons Why medical Claims were being Denied and your activity Plan. Which is very helpful if you ask me and you. 10 tasteless Reasons Why medical Claims were being Denied and your activity Plan

(1) Incorrect patient's information (insurance Id# , date of birth) If you are submitting electronic claims, Avoid entering patient's insurance whole with characters like an asterisk (*) and dash (-) in between the alphanumeric numbers because these characters can be recognize by electronic as unrecognizable. Just check on this issue with the clearinghouse or your assistance provider. all the time make a copy of your patient's former & secondary insurance card on file (copy front and back!). Make sure to get a copy of their new card (if there is a change).

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(2) Patient's non-coverage or finished coverage at the time of assistance may also be the suspect of denial That is why, it is very leading that you check on your patient's benefits and eligibility before see the patient (unfortunately, I have seen practices who does not check on benefits and eligibility on their patients so they end being not paid for the assistance they rendered to the patient)

(3) Cpt/Icd9 Coding Issues (requires 5th digit, outdated codes)--- be careful

also with your secondary code! Claims may be denied even if the qoute was just because of the secondary Cpt/Icd9 code! Again as I previously pointed out with my other articles on tracking your claims, with this problem, discuss solving the coding error rather than how much you want to get reimbursed. Most of the insurance companies will help you with codes (in fairness!!) and they also wise up you on outdated codes, or codes that requires a 5th digit. Be nice with the claims department! (at least you try!)

(4) Incorrect use of modifiers! (be right with bilateral procedures!, modifiers for professional and technical component, modifiers for multiple procedures, postoperative period, etc.)

(5) No precertification or preauthorization obtained (if required) It is so hard to file an appeal when the claim or assistance was non-precertified. Avoid it from happening!

(6) No referral on file (if required) Note: Hmos all the time requires a referral! (remember that!)

(7) The patient has other former insurance or the patient's claim is for workman's comp or auto accident claim! It is the responsibility of your front desk staff to get all the vital information before the patient can be seen. Remember that if this is a workman's comp or an auto accident claim, you need a claim whole and the adjustor's name. Services are all the time preauthorized!

(8) Claim requires documentation & notes to maintain curative necessity A well documented curative records is a good practice!

(9) Claim requires referring physician's info (with Upin ofcourse!-this will be soon substituted by an Npi or the National supplier Identification number)

(10) Untimely filing Unfortunately most of the insurances does not accept your billing records on your office computer that shows that date(s) you billed the insurance! They want a receipt from your electronic receipt or for postal mail, obviously they want a receipt too! a tracking whole maybe? certified letter receipt? If you are submitting claims by electronic, make sure you create transmission reports/receipts. Your reports must read "accepted" and not "rejected". File all these transmittal reports/ and receipts and a very safe place! If you are sending claims by paper or postal mail, it is a good idea to send your claims as certified mail with tracking number, keep your receipts!!

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