Top 3 Reasons for Denial of Insurance Claims

Insurance ClaimOn average, high-performing medical practices receive denials in 4% of insurance claims annually, according to the report by the Performance and Practices of Successful Medical Groups.

Medical claim denial is common whenever medical practices collect payments from private insurance companies. Experts from Apex EDI also note that appealing to these deals is a waste of time and resources, and it can be stressful for the whole practice. However, medical practices can prevent claim denial by addressing the most common reasons for this.

Here are some of the top three reasons for medical claim denial:

  1. Incorrect Patient Information

Denials mostly occur due to an error in the registration process of the claim. Outdated patient information and missing or incorrect patient’s subscriber number are the most frequent errors in this process. Physicians cannot rely heavily on the billing staff to address these errors daily. Thus, to avoid this, set up a management system that makes sure that all forms are complete with the correct information before the patient leaves the practice.

  1. Ambiguous Diagnosis

Insurance companies also deny claims with indefinite codes of diagnosis. Medical practitioners should always make sure that their diagnosis matches the codes of the insurance companies. Medical practices can set up a system that alerts them whenever there is a need for more detailed codes. They should also communicate with the payers regularly regarding their diagnostic codes.

  1. Illegible Claims

Claims become illegible if there are issues with the submitted documents. This usually happens when insurance companies require submission through the mail. The medical practice must ensure that their documents are legible enough for a scanner before sending them to the payers.

Addressing these reasons immediately is not only beneficial to the billing aspect of the practice, but it also helps the whole practice to focus more on patient care and treatment.