Medical Billing Course Online – Avoiding Claim Rejections

In medical billing, one doesn’t want rejected claims. However, rejected claims will happen. It is important to do our best as medical billers to minimize the amount of claims rejections we receive. How can this be done? Following good medical billing procedures will assist in reducing the amount of rejected claims and will speed up the reimbursement process.

When filling out claim forms, make sure that you do not mistype important information like the patient’s name, date of birth, and social security number. Make sure that the insurance information is current and correct on the form.  Avoiding careless typos is key in reducing claim rejections. When the patient is giving you information or if you are inputting it from the patient medical record, make sure to not type so fast that you make a mistake. Review the spelling of the name, date of birth, and social security number.

Medical Billing Course Online – About Claim Denials

Also, make sure the diagnosis and procedure codes are a good match. Whereas this is the job of the medical coder, as the medical biller, you should review the diagnoses and procedures listed on the claim for compatibility. For example, if the patient came in and the diagnosis is “sore throat,” and the procedure is “tonsillectomy,” this would be “out of the ordinary.” Now, repeated sore throats over time with infected tonsils, would warrant a procedure of tonsillectomy.  If a person has an ingrown toenail as the diagnosis, and the procedure is a throat culture, it is evident there has been a mistake either in the documentation itself or the codes that the medical coder chose for the encounter.

The main reasons for claim denials are incorrect information being mistyped on the form, and the diagnosis and procedures not matching.  Review all claims for errors before submitting to reduce the amount of denied claims. When you do get a denied claim, follow up on it quickly and resubmit. Your job as a professional medical biller is to submit claims properly, quickly, and to follow up on them in order to maximize reimbursement for the facility you work for.

By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years.  Interested in quality medical billing training? Click Here for Medical Billing Courses

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