Top 6 reasons behind claim Denials

Top 6 reasons behind claim Denials

Are you experiencing numerous claim denials? Medical healthcare can increase the chances of higher reimbursement by knowing the reason behind denied claim and taking necessary steps to prevent these errors.


Let’ see the top 6 reasons behind claim denials:

Duplicate Claims

Medical practices and hospitals plays huge part in generating duplicate claims that results in largest percentage of claim denials. The front office hits resubmit by not hearing back from insurance that resets the clock again to the time to pay a claim. A duplicate claim either delays or denies the claim processing.

Missing or Incorrect CPT Modifiers

CPT modifiers indicate procedure or service that gets altered by specific situation but doesn’t get change in code or definition. These modifiers strives to allow special consideration to make payment. Filling correct CPT modifiers becomes crucial to get claims paid in the right amount.

A missing or incorrect modifier will result in losing thousands of dollars or an overpayment services. Missing or incorrect CPT modifiers are most common reasons behind denied claims.

Lack of Information

Lack of information are most prevalent mistakes in claim processing. Basic information such as name and DOB are the most common mistakes. Physician are just leaving money on the table by not examining and resubmitting claims.

Expired Eligibility

Many healthcare practices verify coverage prior to avoid any issues. The most common claim denials involves verifying patient’s health insurance coverage.

Many cases practices check the eligibility while making appointment but the coverage can be dropped between the actual visit and appointment period. This makes it important to perform the eligibility check again.

You can avoid another claim denial by verifying when procedures are not covered by insurer. Real time verification can avoid the problem of claim denials.

Expired Time Limit

The exceeding time limit can cause hole in the physician pocket. This reason causing to claim denial can be easily avoided. Mostly physicians gives larger claims their priority, which means small money claims are neglected or put on backburner. This result in small claim denials and eventually adding up to a lot of money.

Billed Amount is Incorrect

The claim amount can be missing or incorrect causing claim denial. In order to make sure that the billed amount is correct, all the charges should be included on every line without any decimal point. The billed charges should be numeric and without any space.

We all have observed that medical claims are hassle and result in financial difficulties. The above discussed reasons show that many of these mistakes can be easily avoided. These mistakes can result in not getting reimbursed properly. Many healthcare industries are hiring medical coding and billing industry to avoid these mistakes.