The best way to keep your income stream flowing properly is
to prevent claim denials. Read below for the top 7 denial reason codes and prepare a strategy to keep them to a
minimum in your practice.
By utilizing an advanced Medical Practice Management Billing
Software like Iridium Suite from Medical Business Systems, many of these types
of denials will become a thing of the past.
1.
18 -
Duplicate claim/service.
Manual keying of services lends
itself to duplicate entry of those services.
A configurable Claim
Scrubber as found in Iridium Suite
will check each service entered and alert the user immediately if the same
service is already on record.
2.
16 -
Claim/service lacks information which is needed for adjudication.
Some payers have specific claim
rules that require “non-standard” 5010 format information be included on their
claims. An example is the rendering
provider’s Taxonomy code in addition to the standard NPI. Iridium Suite allows the user to include this specialized data on
the claims to those individual payers as needed.
3.
97 -
Payment is included in the allowance for another service/procedure.
Government payers, such as
Medicare, as well as the larger Commercial payers have adopted the NCCI
standard for “bundled” services. The
Iridium Suite Claim
Scrubber comes standard with all current NCCI edits built in. The Scrubber alerts the user when entering
two or more procedures that are considered inclusive of each other.
4.
29 -
The time limit for filing has expired.
Payers each have their own time
filing limits guidelines for claim submission.
It can be as short as 60 days, or the current Medicare limit is 12
months. The sooner you submit your
claims, the quicker you will receive your payment and eliminate the risk of
untimely filing denials. With the Connectivity
Clearinghouse within Iridium Suite,
you can import patient demographic and service data directly into the billing
software from your EHR/EMR. Your patient and charge entry process can be
almost completely automated allowing for close to “real time” claims submission
for your services.
5. 50 - These are non-covered services because
this is not deemed a ‘medical necessity’ by the payer.
The key to preventing these types
of denials is being aware of your payers Medical Policies. These two Biller’s
Blogs provide insight on both Commercial Payers and Medicare:
6.
140 -
Patient/Insured health identification number and name do not match.
By utilizing the Real Time Eligibility
function in Iridium Suite, you can
virtually eliminate denials like the one above or similarly “subscriber not
eligible at time of service.” You will
be able to successfully submit charges to the correct active payer with the
proper identification number and receive your proper claims reimbursement on the first submission.
7.
197 -
Payment adjusted for absence of precertification/authorization.
A medical billing software with the ability to indicate payers
requiring authorization as well as track a multiple service/visit authorization
as it is assigned to the performed procedures is crucial in assisting office
staff with this issue. Iridium Suite provides a specific area
in the patient insurance information section to indicate authorization
requirements and to record the authorization details. Before a claim can be submitted, it is
scrubbed for authorization requirements and will warn the user if the
authorization is missing. You are unable
to submit the claim without the appropriate authorization.
By being aware of the common denials your practice receives,
you can develop the necessary processes to prevent them before they
happen. Having the best medical practice billing software, Iridium Suite, can
give you a head start with its many advanced functions.
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