Once the charge entry is done, the next step is claims submission through the practice management system. Claims are submitted via a clearing house or to the insurance company through a cloud-based system.
Incorrectly captured claims result in claim denials and loss of revenue for the medical practice. Here are the top reasons for claim denials:
- The claim is submitted late.
- The insurance number is incorrectly captured.
- The claim submitted is for non-covered services.
- The service is not viewed as a medical necessity (this is usually because of insufficient documentation to support the physician's diagnosis).
- The service is incorrectly bundled, or the code used is for a higher-paying service.
- The incorrect modifier is used.
- A duplicate claim is submitted.
- The patient deductible is not met.
- The benefits have been exhausted.
- Prior authorization is not attached.
- Demographic information is incorrect.
- The provider is out-of-network.
If your medical practice regularly faces claim denials, you must improve the charge entry and claims scrubbing processes. An efficient way to make that change is through outsourcing charge entry and claims submission to an experienced medical billing partner.