The Top 10 Reasons Why Your Medical Billing Claims May Be Denied

The Top 10 Reasons Why Your Medical Billing Claims May Be Denied

We understand how frustrating it can be when you have medical billing claims rejected. Denied claims cost you money and significant time trying to fight denials or collect money from patients. Knowing these common reasons why medical billing claims are denied is key to reducing their occurrence:

  1. Missing information. If you are missing information on a claim or you do not have all of the required documentation, it is likely to be denied.
  2. Transcription errors. Accuracy is the key to successful medical billing. One typo in any part of the required information can create an error resulting in a denied claim.
  3. An error in the company billed. Patients often change health insurers which means unless careful attention is paid to insurers and service dates, your claim could go to the wrong company
  4. Patient obligation mistakes. If you receive a denial with a code related to a patient’s obligation you need to know which of the following reasons applies:
  • The patient still needs to meet their deductible.
  • The patient needs a referral.
  • There is no coverage for the service.
  • Information needed to determine coverage is missing.

Another reason? Their care may be covered by another insurer, so check with the patient to see if they have alternate insurance.

  1. Contractual obligations. Each provider has a unique contract with health insurance companies with certain requirements for billing related to timeliness, duplicate claims being filed (see below), lack of certification for the service and others. If these are not met, a denial may be issued.
  2. Duplicate billing. Submitting a claim more than once is a surefire way to have it denied. This is easily done however, if you are using software which automatically bills for certain services.
  3. Overlapping claims. An overlapping claim is when the service period for one claim appears to overlap with another. Distinct from duplicate billing, these denials sometimes occur when a patient seeks care from multiple providers. For instance, a person who sees two doctors for a dementia consultation without asking for a second opinion referral may have a claim denial because the two consultations overlap. The denial should provide clear information about why there is overlap. You may be able to fight it.
  1. Coverage exclusions. It is the rare insurer which doesn’t have exclusions for at least some procedures. However, denials for most basic healthcare services are not common—it is more likely that the denial resulted from the claim being billed or coded incorrectly.
  2. Coding issues. Bottom line: If a bill isn’t correctly coded the insurer is not going to pay it. Given the complexity of medical billing codes and the variance in billing systems for different insurers, it is relatively easy to make mistakes in this fashion. This is why having medical billing support that is accurate and extremely thorough is key.
  3. Lack of experience. As you can see from the other reasons above, accurate and efficient medical billing requires expert knowledge of insurers, providers, billing codes and much more. Having your billing handled by an in experienced individual or company will increase the denials you receive as well as creating in frustration and revenue loss.

Reduce revenue loss from medical billing rejections with help from Dominion Revenue Solutions. As an experienced, affordable and trusted partner to HHAs, we are dedicated to helping agencies reduce medical billing denials—by accurately and precisely billing medical claims first time. We can help your agency, too! Don’t waste your precious time chasing denied claims and lost revenue, let us help! Reduce your revenue loss from denied medical claims in 2020 and beyond by contacting us at 888-471-9333.

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