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Common Reasons for Insurance Claim Denials

May 23, 2019
Insurance claim denials can be very inconvenient for patients and can affect a practice’s ability to receive payment for services rendered. Preventing insurance claim denials before they ever occur can help your practice to more efficiently receive moneys earned and to keep a better relationship with patients. Patients will be more likely to stay loyal to your office when their claims are routinely paid as expected. In order to prevent claim denials, it is best to understand some of the common reasons for them.

Waiting Too Long to File Claim

Insurance claims generally must be filed within 60 to 90 of services being performed in order to be paid. Disorganization often lies at the root of delayed claim filing. It is important to make sure there is a convenient system in place that allows claims to be filed quickly and efficiently, so that claims are not lost and filing is not delayed.

Submitting Duplicate Claims

If a duplicate claim is filed before an insurance company has responded to the first claim, it may result in a claim denial. Multiple employees may also submit a claim if there is not an established procedure in place for claim filing. Having a system in place with claims tracking can help to avoid this common error.

Claims Filed with Information Missing

Missing patient information may be an error on the patient’s part or may be an administrative error on the part of the practice office staff. Either way, if information such as the patient’s birth date or member number is incorrect or missing when the claim is filed, it may be denied. It is important to always double check this type of information before filing claims, as the few seconds spent on double checking can save labor hours and frustration in the future – and may help you to retain a patient.

Incorrect Coding

ICD-10 has a lot of advantages over previous coding systems used for medical billing, but the volume of codes can get confusing. Implementing high quality medical billing software can help to ensure correct coding. Most systems will flag potential errors before allowing you to send claims, which may be very helpful in preventing denied claims.

Failure to Identify Medical Necessity

Insurance companies require some sort of proof of medical necessity for certain procedures. Failure to provide adequate documentation may result in claims denials. If medical billing software is integrated with patient EHRs, it becomes much easier to provide the documentation required in order to ensure claim acceptance. If your practice could benefit from implementing medical billing software, contact us today.

For informational purposes only.