What are the Reasons For Denied Claims
Almost every medical coder has seen denied claims. Getting familiar with the reasons for these denied claims will increase the ability to prevent them, in the future. Based on the explanation of benefits (EOB) alone, sometimes, it is difficult to identify the specific reason for the denied claim. Electronic health records (EHRs) contain many with CPT(R) and ICD codes. It is possible that the data integrity of the codes may not conform to current guidelines, as the code sets change yearly. There are many instances when recently deleted codes are inadvertently submitted to payers, in the case of an invalid CPT(R) procedure code. Cash flow and the financial performance of a practice can be affected by Claim denials and can be a major source of frustration for physicians and their practice managers. In spite of office procedures being good in gathering correct information and submitting clean claims, at least 5% of denials for claims will be seen. ?Claims can be denied incorrectly”. The provider may lose out on that money, if the person responsible for reading the explanation of benefits (EOBs) doesn?t understand or recognize the error. This document helps in understanding what portion of the bill is being paid and why all or part of it is being rejected.