Medical billing denials can be a major setback, and many common mistakes can lead to them. Here are some common medical coding and billing mistakes that can lead to denials. Businesses should avoid:
Nonspecific Claims
Every diagnosis needs to be coded to the highest level applicable, which entails including all of the digits contained in the code. For instance, a hypertension diagnosis starts with 401, but needs to be measured in 4 digits, including 401.0. Some diagnoses, such as diabetes, even require a fifth number.
Missing Information
Any details that are missing from a claim can also result in a denial. Common types of missing information include the date of the accident, date of onset, and date of the medical emergency. Businesses should make sure that all of the necessary information is included, along with supporting documentation.
Claim Isn’t Filed on Time
Even if a business submits a proper claim, it can still be denied if it doesn’t fall within a specific timing window. Medicare providers should understand that the Affordable Care Act changed the submission period to 12 months. The start date for Medicare claims is the date when the service was provided or the “From” date that appears on the claim form. A Medicare claims processing contractor must receive the form by the end date, which is exactly one year following the start date. Even if the claim is sent before the end date, it will be denied if the contractor receives it after the end date. This is why timing is crucial.
Incorrect Coding Issues
If a business is using an out-of-date codebook or an incorrect code is entered, this could result in medical billing denials. Businesses should make sure that all of their codebooks are current, as the use of outdated books such as ICD-9, CPT, HCPCS, and super bills will culminate in a loss of overall revenue. Poor documentation is another potential issue because the documentation that fails to support payment for the services billed or that is missing a specific element can also result in a denial. They should ensure that everything documented is also billed.
Inadequate Patient Identifier Information
Businesses can avoid this issue by making sure the patient’s name is properly spelled, and that the date of birth and sex are accurate along with the correct insurance payer and policy number.
These are some of the most common issues that result in medical billing denials.
