A rejected claim contains one or more errors found before the claim was processed. Errors will prevent the insurance company from paying and the rejected claim is returned to the biller to be corrected. A rejected claim may be the result of a clerical error or a mismatched procedure and an ICD code. A rejected claim can be resubmitted once the errors have been corrected. If you follow some tips then you can reduce your claim rejections.
Common causes of claim rejections:
- Incorrect patient demographics
- Incorrect coding
- Patient eligibility
- Out of date information
- Duplicate claim
- Incorrect place of service
How to reduce claim rejections:
Talk to the front desk:
The front desk usually collects the patient and insurance information that gets entered into the computer system. Billing needs to communicate and work closely with them to be able to obtain correct information. Getting updated information from the patient at each visit will help to get your claim paid.
Verify patient coverage:
Make sure you have correct insurance information to bill the claim by verifying the eligibility of coverage at each visit. While verifying patient coverage, your first call is probably to the payer, who can verify plan benefits with regard to in-network coverage and out-of-network coverage.
Double check your work:
If you are working fast to complete the assigned work then making typos is very common. Forgetting a digit in an insurance ID or transposing a number can cause claim rejection. Being diligent about double checking your work will automatically reduce the risk of denial.
Stay up-to-date on insurance carrier information:
Monitor your claim denials on regular basis. Something as simple as new insurance company requirements that your biller did not know about can lead to multiple claim rejections.
File claims within 24 hours:
Avoid timely filling issues and file claims immediately. You may have to put a claim on hold to obtain correct information or ask the doctor about code, but don’t forget about it. A good medical biller has a way to handle those claims systematically. It’s also important that you work the claims rejections right away, as the time is essential in both cases.
Preauthorization and other numbers:
Make sure that any authorization number, CLIA number or NDC number for medications, vaccines, and injectable are submitted with the claim. These are easy to find through many helpful websites, as these numbers are required by the FDA.
Submit to correct insurance:
It should come as no surprise the selecting the wrong company to send your claim will result in a speedy rejection. This is another reason it’s so important for the front desk staff to verify insurance with the patient at each and every visit. If the patient has multiple insurance carriers make sure to select the correct one as primary.
A provider who is not participating with insurance may also cause your claim to be rejected. If your providers are not credentialed with insurance carrier it’s important to have a system in place to provide your patient an estimate and make them pay in cash.
Train your billing staff to handle rejections quickly. As mentioned, time is essence on both sides of fences, not just when submitting. Far too many claims never get paid simply because rejections aren’t handled appropriately and that can be a huge drain on your practice earning.
There is a lot of work involved to ensure you are submitting a clean claim. Many practices struggle with rejected and denied claims and have turned to outsource billing companies for help. The firm like MBC (www.medicalbillersandcoders.com) has experienced billers and coders who are qualified to deal with the complexities of medical billing. Outsourcing medical billing can be a great choice for your practice as it takes the burden of medical billing off of your staff so you can focus on patient care.