Insurance denial is when an insurance company declines to cover a medical claim submitted by a healthcare provider or patient. Common reasons for insurance denials include lack of coverage for the specific treatment or service, errors in the billing or coding of the claim, and the patient not meeting the requirements for the coverage.
Common medical billing errors that can lead to insurance denials include:
Incorrect coding of the procedure or diagnosis
Lack of preauthorization for a procedure or treatment
Billing for a service that is not covered by the patient’s insurance plan
Providing incomplete or inaccurate patient information
Billing for a service that was not actually provided
Failure to appeal denied claims in a timely manner
Double billing for the same service.
To fix these errors, healthcare providers and billing staff can take the following steps:
Review the patient’s insurance coverage and the specifics of their plan
Verify that all necessary preauthorizations have been obtained
Check that the coding of procedures and diagnoses are accurate and up to date
Make sure that all patient information is complete and accurate
Check for any errors or discrepancies in the billing and correct them before submitting the claim
Keep detailed records of all billing and insurance interactions
Appeal denied claims within the time frame allowed by the insurance company.
It’s also a good practice to have a regular internal audit to check the claims, and have a clear communication with the insurance company regarding the denied claims.
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