Top 5 Claim Denials - Implementing Denial Management Strategy

5 Common Medical Practice Denials 5 Commonly Denied Procedures Denials are an ugly reality that every physician practice must address. It’s not a question or whether practices will receive a denial—it’s a question of when and why. RemitDATA—a company that provides comparative analytics data for the outpatient provider market—reported in September 2014 that these five procedure codes most frequently result in unexpected denials: 99213 (outpatient doctor visit, level 3) 99214 (outpatient doctor visit, level 4) 36415 (routine blood capture) 99232 (subsequent hospital care) 97110 (therapeutic exercises) The company uses a comprehensive electronic remittance database to analyze the most frequent reason codes for each of these denials. Consider the following reasons why these denials occur as well as tips to ensure compliance proactively 1. 99213 - Level 3 Established Office Visit Reason for denial: Duplicate claims (reason code 18) Tip for compliance: Using an appropriate frequency code may be helpful. This code indicates that a claim is an adjustment of a previously adjudicated claim, and it reduces the likelihood that a claim will be denied as a duplicate. BlueCross BlueShield of Oklahoma addresses this issue on its Web site. 2. 99214 - Level 4 Established Office Visit Reason for denial: Inclusion of this service in another service/procedure that has already been adjudicated (reason code 97) Tip for compliance: Practices may need to append a mod...
Source: EMR EHR Blog for Physicians - Category: Technology Consultants Authors: Tags: Denial Management Source Type: blogs