4 Tips to Avoid Common Mistakes Resulting in Claim Denials

4 Tips to Avoid Common Mistakes Resulting in Claim Denials

According to a survey, better performing medical groups have just  4.05% claim denial rate. Is your practice facing more than four percent denial rate? Input oversights, manual errors and timing issues results for more denials than any other factor.


Here are 5 tips to avoid common mistakes resulting in claim denials:

Timely filing Denials

These denials are the most frustrating as payer operates on their filing schedules and it becomes easy to skip timing window. Try to document and track each payer’s receipt of claim submission, whenever it’s possible.

At times claims are unfairly denied for timely filing. For instance, when you submit claim properly but the insurance carrier says they don’t receive it prior to the deadline. Start holding accountable for their timely receipt of your transactions.

Missing Information

If your medical staff leaves certain encounter information out of claim, it could come back and haunt you. A detail oriented payer will observe omissions and count such mistakes that can result in claim denial. Claims missing informations, such as prior authorization or missing modifier are the most common reason for claim denial.

Make sure that your medical staff fill all required areas on the claim forms. Your medical biller should double check the usually missing fields and rectify those errors prior transmittal.

Non- Specific Claims

A diagnosis should be coded to highest level for that code which means greatest number of digits for selected code. There are chance of getting denial when medical billing requires seven digit code and you send them six digit code. Always facilitate a dialogue between your coders and billers. Make sure that billers are aware of how truncated codes look like to catch them prior to submission.

Claims Below Payer Standards

There are payers that are sensitive and more demanding to claim issues. Even though every claim you send should be perfect, giving special attention to the requirements of your pickiest payers to help elevate claim quality.

An easiest way is to group your transactions by payer. This helps you to figure out which insurer most often denies your claims.

Working on denied medical billing claims is critical component of revenue cycle management. A proactive method to measure causes and volume of denied billing claims can help you prevent them. Many medical practitioners are outsourcing their coding and billing requirements to submit clean claims in the first go.