7 Most Common Reasons for Claim Denials in 2023

7 Most Common Reasons for Claim Denials

When a claim gets denied, it not only affects the company’s cash flow but also impacts the patient-doctor relationship. Even some denials get claimed by re-appealing but few claims are left on air – that what something your practice and patient would like to avoid.

Poor management in claim processing will negatively impact the revenue cycle. Allzone Management Services Inc. has its own team of medical coders and billers and we provide our best service to keep your healthcare facility healthy. Our mission is to streamline practice revenue by providing the best medical billing and coding services.

Below are the 7 most common reasons that a claim gets denied.

Reasons for Claim Denials:

Late Filing of Claims:

Each claim has given a specific amount of time to submit and for payment consideration. Failing to submit the claims on time will results in healthcare practice paying for it at their own expense. Most of the time healthcare providers will fail to submit claims on time due to incomplete or lost super-bills of some practice services. The claims will be denied even after submitting by correcting it due to the filing date has passed.

Missing Information:

The claims will be denied most of the time because of missing of patient information. The most causes are accident date, medical emergency, or onset.

Inaccurate Insurance ID Number or Out-of-Network provider:

Insurers’ networks will change from year to year and it’s the provider’s responsibility to check the patient information on each visit including insurance change details. If the last insurance cards and ID numbers are submitted, the insurance company will deny the claim. Even entering information manually will result in medical billing and coding mistakes, if staff members are not trained in proper data entry techniques.

Inaccurate Patient Information:

Once the provider receives a claim, should check the Patient’s name spelling, Date of Birth, and Gender as well as insurance payer details, policy number, and valid policy or not? is service covered and the diagnosis code matches the procedure performed.

Improper ICD-10 Coding Use

Each diagnosis should follow ICD-10-CM Standard which includes the maximum digits for the code being used. ICD-10 codes helps to reduce number of codes with its 6th and 7th characters to specify the diagnosis code in code assignment while comparing with ICD-9 codes.

Approval for Preauthorization:

As per survey data physicians are facing difficulties with which tests and procedures require preauthorization from Insurers. Many claims have been denied because of a physician who didn’t follow the insurer’s guidelines for preauthorization.

Using upcode or unbundle:

The billing codes used to get reimbursement for higher-paying services are called upcoding. medical Billing services separately that should appear together are unbundling. Using either this or that results in denial.

Choose Allzone Management Services for managing your claims and Reduce denials

Are you struggling to manage increased medical claim denial? It is recommended to work with experienced and trusted medical billing and coding companies to get faster reimbursement. Allzone Management Services is one of the leading medical coding companies with a successful track record of working with healthcare providers across the United States. Our highly trained and certified medical coders and experienced medical billers will help our clients to run their medical billing business successfully and efficiently.

Get started to reduce your claim denials faster to boost revenue. Reach us at 866-854-2714.