Insurance carriers often deny claims for not being coded to the highest level of specificity or they may consider the diagnosis truncated. As many billers are not coders, they often don’t understand what has gone wrong or how to fix it.
What is the highest level of specificity?
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One of the most important parts of billing is handling denials. Thousands of dollars a year can be lost in providers’ offices that don’t handle denials. In fact, I saw a statistic once that said 47% of denied claims don’t ever get appealed. That is outrageous!
We find that there are three reasons that denials don’t get appealed. The first is that the denial is correct and there is nothing to appeal.
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A recent report from the American Medical Association (AMA) provides some shocking numbers on the cost of inaccurate health insurance claim payments.
It’s not surprising that patients and physicians are frustrated by the high cost of health care due to claim-processing errors by insurance companies that waste billions of dollars every year.
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Medical practices are going unpaid for 25% of the work they perform, according to the MGMA.
Complicated payer processes and constantly changing rules make it difficult for physicians to collect the full amount they are owed. In 7 Best Practices for Medical Accounts Receivable Management you will learn:
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