What are the top types of denials when it comes to medical billing?

Medical billing denials are a big issue for most hospitals. These denials occur when insurance companies refuse to pay for your healthcare services. When this happens, the revenue of the hospital is negatively affected.   

In order to reduce the instances of these denials, you must be aware of the different types of denials that occur. Here are a few of them.  

Duplicate Claims 

If you make two claims on the basis of the same encounter, a duplicate claim occurs. This claim deals with a healthcare service provided by the same professional to the same person at the same date. If you do so, your medical billing coverage will be denied on the basis of a duplicate claim.   

Among all the types of denials, duplicate claims are the biggest reason, with over 32% of medical billings being denied because of it. There are instances when claims dubbed as being duplicate were valid. In such a case, you must apply the correct codes to show that the claim you are making is not a duplicate.   

Overlapping Claims   

Unlike duplicate claims, overlapping claims are a little more complex. This type of denial occurs when one claim comes into direct conflict with another claim. Generally, this happens on the basis of clashing dates. Some examples of overlapping claims are as follows:  

When the claim for a payment cannot be made because payment for the same service has been made already by some other provider.   

When payment for a similar procedure has already been made by the provider in the same time frame.   

Such overlaps can be resolved. However, thorough research is required for it.  

Not covered by insurance/payer  

All healthcare services may not necessarily be covered by your payer or insurer. If you don’t look into the technicalities of your contract before opting for a given service, you might end up with a medical billing denial. In this type of denial, there is very little you would be able to do after it occurs. The best way to prevent this is to look into the nitty-gritty of your contract. Make sure that the service you are getting administered is being covered by your insurance plan. If in doubt, contact your insurer.  

Expired time limit  

You can’t make claims about payables to your insurer years after you have administered a service. Every insurer has a set limit within which you can submit your claims. If you fail to make your claim within the desired time frame, the insurer will not be liable for your medical expenses.   

Therefore, try not to delay your claim submissions. Make them as soon as possible to avoid medical billing denials.  

Conclusion  

Medical billing denials is a source of inconvenience for both the patients and the healthcare providers alike. Being careful and well versed in the contract can save you a lot of hassle.   

Pay heed to the technicalities of your contract. Avoid medical billing denials.  

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