Common Reasons Medical Billing Claims Get Rejected

The denial or rejection of your medical billing claims can be quite disappointing. Despite the excellent work done by the medical billers, your claim may still be rejected for the reasons which might not have even occurred to you.

What are the common reasons that lead to the rejection and how can you make it certain that your claim gets through? Here are the answers.

Failing to file the claim within the stipulated period:

Generally, the insurance companies allow a period of 60 to 90 days to file the claim from the start of service. If your claims are filed after the due date, they get rejected.

Errors in the data:

Incorrect demographic data of the patient and mismatch in the medical codes such as Diagnostic code(ICD-10) and Procedure code (CPT), which are related to the treatment provided by the physician, can result in annulment of you medical billing claim.
Out-of-network Provider:

In case you used a healthcare center for an emergency which does not come with your plan, you may have the chance of your claim getting rejected.

Preauthorization and referral acquisition:

Certain services like CT Scans and MRIs require preauthorization and if the health care center does not provide it, your medical billing claim may get rejected. For some insurance plans, a referral of a physician is mandatory before the service is rendered. Failing to acquire results in denial of the claim.

Loss of Insurance Coverage:

If your insurance coverage is misplaced or lost, or your claim does not make it to the Insurance company on time, the chance of rejection is higher.  

Claim sent to the wrong Insurance Management:

If your physician bills the wrong company in which you have not taken the policy or your file is sent to the wrong managing company, your medical billing claim may get rejected.

How can you prevent the mistakes and avoid Medical billing claims rejection?

Stay vigilant to avoid simple mistakes on your end. You should always consult with your physician about what should be billed and what should not be. Double-check the information related to the patient and insurance company before sending them for processing.

Stay updated with the coding trends; Medical bill coding change over the time with new regulations, newfound illnesses, and new treatments, hence it is important to study the new codes and procedures.

You can follow up with the insurance company on your claims and representatives from the company will tell you if they find any errors which you can correct and resubmit your claim for processing.

These are some ways in which you can prevent rejection of your medical bill claims.