Rejected medical claims come from many sources. The most common is likely keystroke error. That is usually a relatively easy fix and for our business it is also one that is easy to catch. The best method of catching some of these simple mistakes is to use a good scrubber for your claims.

Once the claim batch has been created, as it is processed through the intermediary software, it looks for little inconsistencies. Like an ending date that precedes a beginning date, just little things that can easily get entered out of sequence when you are processing a lot of claims.

Another easy one to get incorrect is term date for procedures and/or diagnosis codes. Once you have used a code in your medical billing system, you should not be able to remove it because of the relational database algorithms. Resultantly, it is easy to use an old code without intending to. Again, this is where a good scrubber comes into play. It can catch those pesky errant codes before the claim gets out the door. By using the scrubber, you are able to quickly get claims corrected, usually within a few hours, depending on how often you drop claims.

Issues with patient and insurance information should be taken care of before you see the patient. I repeat, before you see the patient. Your front office should know in great detail the probability of whether you are going to get paid on this patient. They should have done all of their homework by verifying each and every piece of information.

Some payers are particularly peculiar about not allowing more than one E&M visit in a day. Again, these are questions that can be covered prior to seeing the patient. Once it has been determined the patient may have already seen another provider, the front office can check the insurance company and get the applicable rules.

Coding issues should be non-existent, as the provider and staff should have an in-depth knowledge of what is current, what supports what, and should any modifiers be used to clarify the claim.

Do your homework before filing the claim and you will see better results.


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