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September 8, 2015

What To Do When Your Claim Is Denied

September 8, 2015

Billing and Coding Company

Denied claims by insurance companies are almost inevitable. Don’t let insurance companies take advantage of your practice. There are different reasons claims may get denied. Read more to discover why your practice’s claims may be turned down - and  can a medical billing company can help with that.

Reasons Claims Get Denied

If you wait too long to file a claim, it will most likely get rejected. Don’t wait. Make sure that your medical billing company files all claims within two months of the service. Also, pay attention to all coding. Diagnostic codes and procedural codes should not be missing or incomplete. They should also be accurate. If the code does not correspond with the diagnosis, your claim will get rejected.

Sometimes, the insurance companies are culpable. Insurance companies sometimes do misplace claims. No matter how it may get lost, if the claim does not make it into the system on time, the claim will be denied.

Insurance companies often require not only preauthorization but also physician referral. If a service is performed before receiving both of those, that claim can be denied. Some insurance companies also require that only one service is performed in a day. So, if you conduct more than one service, you may only receive compensation for one.

Of course, when a patient switches insurance plans, you will need to be meticulous in making sure that you know all the new restrictions, that you are listed as a provider for that patient, and that you obtain preauthorization again.

Most importantly, check with the insurance company that the patient has not lost any benefits before performing any services, to help ensure that your practice receives payment.

Manage Your Denied Claims

Establish a way to track your claims. Make a detailed report of all denied claims that you can refer back to at the end of a financial term (quarter or year, etc). Accumulate a comprehensive list to determine the reason behind most of your denied claims.

Figure out how often your claims are getting denied, and whether it is your fault or the insurance company’s. If it is a problem with a particular insurance company, you have something you can address. If it is a problem within the office, you can address that as well. From there, you can develop the best course of action -  perhaps outsourcing the job to a medical billing company.  

Medical Business Management Can Help!

Select an outsourced medical billing company that has integrity, experience, and expertise. Trust Medical Business Management, a company with a proven track record and reliability. With over 25 years of experience, we are here to help.

Contact us today to learn more about how we can help you manage your insurance claims.

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