{"id":1408,"date":"2012-07-10T07:33:06","date_gmt":"2012-07-10T07:33:06","guid":{"rendered":"http:\/\/www.medicalbillersandcodersblog.com\/?p=1408"},"modified":"2025-05-14T11:39:58","modified_gmt":"2025-05-14T11:39:58","slug":"are-you-filing-claims-and-have-one-in-every-three-rejected","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/are-you-filing-claims-and-have-one-in-every-three-rejected\/","title":{"rendered":"Are you filing claims and have one in every three rejected!"},"content":{"rendered":"<ul>\n<li style=\"text-align: justify;\">Filing claims has become more complicated as health insurers tighten eligibility requirements, and the chances of claims being denied have increased substantially<\/li>\n<li style=\"text-align: justify;\">Hence when a claim is filed, there is a fair possibility it will be denied and most providers are struggling to balance their busy time schedules to implement additional care while filing claims<\/li>\n<\/ul>\n<p align=\"center\"><strong><span style=\"text-decoration: underline;\">Industry Standards say&#8230;<\/span><\/strong><\/p>\n<table border=\"1\" width=\"80%\" cellspacing=\"0\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td valign=\"top\"><strong><span style=\"text-decoration: underline;\">\u201cAverage rejected claim rate is reported at 30-33%\u201d<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">According to top ten biller\u2019s investigation on all Healthcare provider\u2019s \u00a0the claims rejections rate\u00a0 is:<\/p>\n<ul>\n<li>30% with Federal Insurance Payers<\/li>\n<li>33% with Commercial Payers<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td align=\"left\" valign=\"middle\">This rejection rate is observed in Podiatry, Pediatric, Allergy &amp; Asthma, Dental and normally all specialties-\u00a0 if proper EDI or clearing house and payer set-up is not done<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p align=\"center\"><strong><span style=\"text-decoration: underline;\">Why do claims get rejected?<\/span><\/strong><\/p>\n<p style=\"text-align: justify;\">Claims may get rejected for just a simple mistake like \u2013 Inaccurate coding errors by untrained staff, change of address not supplied to insurer to something complex like &#8211; Medical procedure ruled &#8220;experimental&#8221; and not covered.<\/p>\n<p align=\"center\"><strong>Few reasons why claims get denied by insurance carriers:<\/strong><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"400px\">Ailment not being covered in the health insurance policy<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Procedure deemed medically unnecessary<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Incomplete documentation<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Improper claim form filled<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Claim not filed in time<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Pre existing disease which was not disclosed<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p align=\"center\"><strong><em><span style=\"text-decoration: underline;\">How does it adversely affect your practice? <\/span><\/em><\/strong><\/p>\n<p>As far as possible steer clear of rejected claims <span style=\"text-decoration: underline;\">as only one rejected claim can put your revenue behind<\/span>, and bring on additional tasks like:<\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"400px\">Reopening patient\u2019s folder &#8211; second review &amp; research of the notes<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Claims to be compiled again<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Double checking of codes again to ensure usage of the latest codes<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Re- submission of claim<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\">Insurance carrier may also need to be contacted<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p align=\"center\"><strong><em><span style=\"text-decoration: underline;\">Solution &#8211; Reading between the lines to increase your bottom line and revenue!<\/span><\/em><\/strong><\/p>\n<p align=\"justify\">According to most of the patient-advocacy organizations between 50 \u2013 70% of disputes are resolved through initial appeals made directly to health insurers.<\/p>\n<p align=\"justify\">However this could be rather time consuming and opting for outsourcing your medical billing claims to a third party partner could help you get rid of the hassles that a rejected claim can cause.<\/p>\n<p style=\"text-align: center;\" align=\"center\"><strong><span style=\"text-decoration: underline;\">Achieve the following benefits with MBC:<\/span><\/strong><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"500\">\n<ul>\n<li>Considerable reduction in average rejection rate to less than 10%, due to reduced errors<\/li>\n<li>Efficient handling of claims resulting in increase of approximately 25% of your reimbursements<\/li>\n<li>In house staff is hassle free of all paper work involving medical billing and in turn able to assist you in managing your practice better<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p align=\"justify\">MBC\u2019s expert Billing &amp; Coding team will be able to efficiently handle your entire billing process, medical being their core process, besides providing updates about new rules and changes for each specialty.<\/p>\n<p align=\"justify\"><a href=\"http:\/\/www.medicalbillersandcoders.com\">Medicalbillersandcoders.com<\/a> has been assisting in revenue maximization for healthcare organizations through their revenue management model encompassing: Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, A\/R Management, and Financial Management Reporting. All this along with weekly reporting and consultancy ensures our physicians receive the revenue they deserve.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Filing claims has become more complicated as health insurers tighten eligibility requirements, and the chances of claims being denied have increased substantially Hence when a claim is filed, there is a fair possibility it will be denied and most providers are struggling to balance their busy time schedules to implement additional care while filing claims [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[18,15,20,9,12],"class_list":["post-1408","post","type-post","status-publish","format-standard","hentry","category-claims-denials","tag-denial-management-2","tag-medical-billing","tag-medical-billing-and-coding","tag-medical-billing-companies","tag-medical-billing-services-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Are you filing claims and have one in every three rejected! - Medical Billing and RCM Blogs<\/title>\n<meta name=\"description\" content=\"Learn about Are you filing claims and have one in every three rejected! in our latest blog post. 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