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Get Paid Instantly by Knowing the Claims Rejection Reasons

Do you know why your claims to the insurance companies are getting rejected? conducted a survey on the most common causes of delay in getting paid. Providers can use this information to rectify their medical billing process and remove bottlenecks.

Healthcare practices can instantly tap onto their rightful yet held up monetary resource by knowing why their claims are being rejected. Optimizing the revenue cycle of your practice can be quite a task if your medical billing process is slack. The explanation of benefits (EOB) from the insurance companies is the most crucial pointer that shows you the scope of improvement in the same.

The medical billing cycle of a healthcare practice is the lifeline of any medical organization and factors like patient satisfaction are also associated with it, which makes it even more worthy of paying careful attention. Research shows that the EOB is the most important document that can help practices streamline their claims submissions and document error free bills for the insurance companies to reimburse.

Most Common Reasons for Claims Rejection

As a provider you can insist or train your billing staff or partner to carry out the following to scrutinize your claims process. These are areas that call for attention for the billing department while submitting claims:

  • Incomplete form of submission:
    The CMS 1500 claims form is often filled in incomplete and invariably gets disqualified in the first stage of payment itself. Do take a note of whether your biller is including the reference of primary EOB while filing the follow up form
  • Faulty coding :
    Incorrect or erroneous coding comes next in line, be it the CPT / ICD codes or modifiers. False information or insufficient knowledge of the biller about the disease, i.e. knowing whether it is covered under the insurance plan or not, and billing inappropriate code
  • Change of insurance policy / policy exchange:
    Pay attention to the patient file to determine if the patient changed his insurance policy or resubmitted a new one under policy exchange program or has an additional policy to support the course of treatment
  • Duplication of claims :
    Avoid chances of audits by carefully screening the number of claims submitted for a single patient. Repeated submissions can invite unwanted audits for your practice
  • Patient benefits exceeded : It is not only important to be vigilant about the entries you fill in the claims submission form but also to keep a tab on the benefit amount of your patient. If complete benefits are met, payments claim will be rejected

If you have outsourced your billing services, check with your billing partner if they are looking into these factors while performing their tasks. Proficient billing service providers have the facility for their clients to keep a track of the online billing process through electronic mediums. has remained a successful outsourced billing partner across all over the United States for the last 14 years and they offer specialized billing services for 42 specialties. The team handles each superbill with utmost diligence and efficiency to keep the AR age low and work on getting timely updates on the reimbursements. The dedicated team studies every aspect of the revenue cycle management for every client. They help detect the wanting areas and work accordingly to strengthen the weak links.

Prerna Gupta, Media Relations
108 West, 13th street,
Wilmington, DE 19801

Tel: +1-888-357-3226
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