According to the survey, conducted by the Kaiser Family Foundation, a non 18% of the claims were rejected by insurance companies in 2017. Denial rates for medical claims have been increased to 40% when not seeking help from professional medical billing services. There had been similar claim denials rate in recent years (2015 and 2016)
When the claim denials happen, the physicians have to bear the loss of thousands of dollars. Naturally, this creates a sense of frustration in the physicians.
Here are the seven reasons that your claims are not getting approval.
Incomplete coding is the primary reason for revenue loss.
Each coder must incorporate the relevant codes in medical billing. To overcome this issue, you can follow the ICD-10-CM standard, which lists all numbers o and codes used to specify an appropriate medical condition. There are notable differences between ICD-9 and ICD-10 codes, including codes that define the injuries. After you add more numbers like six and seven characters, the new symptoms codes minimize the number of regulations, and the more excellent the codes assignment will be.
Incomplete information
A denial may occur due to missing information. For instance, when there is no information related to the accident date or relevant codes that specify the human condition.
Late claim submission
You have to face the claim denial when it is submitted after the due date, and the Medicare claims must be filed within the given time. For instance, commercial carrier has different rules and regulations for reimbursements.
Wrong or inaccurate information related to the patient
You must bear in mind that correct spelling matters a lot. You have to face claim rejection as you have to do when you have mismatched names in your ID card etc. if you want to make sure the insurance payer is correct, then you need to verify that patient’s name has been written correctly.
Not paying attention to a preauthorization.
A survey was conducted to know the reason behind the rejection due to pre-authorization issues, and the results were shocking! Many physicians determined that they had faced denial claims due to preauthorization negligence.
Unbundling or upcoding
The accurate entry of the relevant codes is required for claim reimbursement. In medical billing service separately, that could have been submitted together, but not doing so may result in claim rejection
Submitting Duplicate claim
As often happens in the rejection of the claim that we submit the claim twice. For instance, the claim submission for some treatment for the same patient to the same insurance company will not get approval. This is a common problem that physicians face when they get a claim rejection. To minimize the details and get your claims accepted, you must train your staff from expert medical billers and revenue cycle managers.
How to minimize the claim denials?
Code errors are the first and foremost reason that contribute a lot to claim rejection. As these are the severe cases in the American hospitals nearly 750 hospitals, there had been 81% of claims denials due to coding errors.
Secondly, choose the better claims management software that will get you transparent results and advanced features to avoid mistakes that hinder timely payments. You will also get a convenient alter before the deadline to prevent the claimed failure.
Let the Physician Revenue group handle your revenue cycle management task with accurate medical billing services, and hats off your burden. Outsourcing the paper by getting medical billing services will maximize the revenue and decrease the claim rate.
