Medical Billing Forum

Payments => Insurance Payments => Topic started by: shellykelly on March 29, 2011, 02:40:06 PM

Title: Student Question about denied claims.
Post by: shellykelly on March 29, 2011, 02:40:06 PM
I'm writing an essey about the number one reason claims are denied. It would be nice to hear the opinion of someone who is working in the "real world" of billing. What reason have you found that is on the top of the list of denials? Is it patient info.? Do you think this may be the easiest to avoid?
Title: Re: Student Question about denied claims.
Post by: rdmoore2003 on March 29, 2011, 04:05:28 PM
For me it would be that the information given to us by parents is wrong.  ex:  my daughters date of birth is 9/15/95, but insurance has it as 9/16/95.   IT MAKES A DIFFERENCE.
Title: Re: Student Question about denied claims.
Post by: pattil88 on March 29, 2011, 05:02:59 PM
In many of the reports I've seen, "Duplicate Service(s)" usually ranks at the top. I think alot of that has to do with practices that just automatically refile claims that have not been processed within a certain amount of time.  I personally don't recommend practices do a rebill unless they are positive the original claim was not received and/or processed - duplicates can trigger payer flags for a possible audit.
Title: Re: Student Question about denied claims.
Post by: AdvancedSpine on March 31, 2011, 09:17:41 AM

Patient information has to be accurate so we always make sure it is correct to avoid denials.  For us (we bill a lot of PIP) the most common reason is that the patient did not submit a piece of information to the insurance and we cannot avoid it.  As far as something we could avoid, entering the wrong claim # or a name different than what the insurance has on record or mailing the claim to the wrong insurance company would be a reason.
Title: Re: Student Question about denied claims.
Post by: DMK on March 31, 2011, 10:44:50 AM
Without question, after billing for 10 years, incorrect patient/insurance information.  And that includes bad data entry!