Seeing more than your fair share of denied medical claims?
Increase the chances your medical practice will keep more of the revenue you earn by focusing on 5 commonly denied procedure codes — and the reasons driving the denials.
Analysis of electronic remittance claims submitted in the final 3 months of 2014 reveals the most commonly denied procedures:
- ‘Outpatient doctor visit, level 3’ (CPT code 99213)
- ‘Outpatient doctor visit, level 4’ (99214)
- ‘Routine blood capture’ (36415)
- ‘Subsequent hospital care’ (99232)
- ‘Therapeutic exercises’ (97110)
Family medicine, internal medicine and pediatrics essentially tied for specialties with the most unexpected denials at 10% each, according to this study from RemitDATA. Radiology and orthopedic surgery followed closely behind.
Beware the Bundle
Denial reason codes include:
- “Duplicate claim/service” tops the list of reason codes behind the most commonly denied procedures (reason code 18)
- While bundling services may save you money on your cable bill, bundling your CPT codes could cost you. Unexpected denial caused by coverage within a bundled service — officially known as claim adjustment reason code 97 — was the #2 reason for claim denial, according to a Physicians Practice infographic of the study results.
- Lack of information or medical billing error (reason code 16)
- Non-covered charges (code 96)
- Care possibly covered by another payer (code 22).
Using the right modifier can boost your medical revenue cycle by helping to avoid claim denials, especially to justify a distinct procedure typically billed within a bundled service.