Tuesday, May 29, 2012

10 coarse Reasons Why curative Claims were being Denied and your performance Plan

Claim Management - 10 coarse Reasons Why curative Claims were being Denied and your performance Plan
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(1) Incorrect patient's data (insurance Id# , date of birth) If you are submitting electronic claims, Avoid entering patient's assurance amount with characters like an asterisk (*) and dash (-) in in the middle of the alphanumeric numbers because these characters can be identify by electronic as unrecognizable. Just check on this issue with the clearinghouse or your aid provider. all the time make a copy of your patient's primary & secondary assurance card on file (copy front and back!). Make sure to get a copy of their new card (if there is a change).

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(2) Patient's non-coverage or concluded coverage at the time of aid may also be the theorize of denial That is why, it is very important that you check on your patient's benefits and eligibility before see the patient (unfortunately, I have seen practices who does not check on benefits and eligibility on their patients so they end being not paid for the aid they rendered to the patient)

(3) Cpt/Icd9 Coding Issues (requires 5th digit, outdated codes)--- be careful

also with your secondary code! Claims may be denied even if the qoute was just because of the secondary Cpt/Icd9 code! Again as I previously pointed out with my other articles on tracking your claims, with this problem, discuss solving the coding error rather than how much you want to get reimbursed. Most of the assurance clubs will help you with codes (in fairness!!) and they also tip off you on outdated codes, or codes that requires a 5th digit. Be nice with the claims department! (at least you try!)

(4) Incorrect use of modifiers! (be right with bilateral procedures!, modifiers for professional and technical component, modifiers for complicated procedures, postoperative period, etc.)

(5) No precertification or preauthorization obtained (if required) It is so hard to file an motion when the claim or aid was non-precertified. Avoid it from happening!

(6) No referral on file (if required) Note: Hmos all the time requires a referral! (remember that!)

(7) The patient has other primary assurance or the patient's claim is for workman's comp or auto crisis claim! It is the responsibility of your front desk staff to get all the significant data before the patient can be seen. Remember that if this is a workman's comp or an auto crisis claim, you need a claim amount and the adjustor's name. Services are all the time preauthorized!

(8) Claim requires documentation & notes to keep medical necessity A well documented medical records is a good practice!

(9) Claim requires referring physician's info (with Upin ofcourse!-this will be soon substituted by an Npi or the National victualer Identification number)


(10) Untimely filing Unfortunately most of the insurances does not accept your billing records on your office computer that shows that date(s) you billed the insurance! They want a receipt from your electronic receipt or for postal mail, obviously they want a receipt too! a tracking amount maybe? certified letter receipt? If you are submitting claims by electronic, make sure you originate transmission reports/receipts. Your reports must read "accepted" and not "rejected". File all these transmittal reports/ and receipts and a very safe place! If you are sending claims by paper or postal mail, it is a good idea to send your claims as certified mail with tracking number, keep your receipts!!

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