Top Five Types of Service Most Frequently Appealed

Top Five Types of Service Most Frequently Appealed

A recent study conducted by Medicare showed that the top five types of services submitted on medical billing forms for payment fell under the following five catagories.

Evaluation and Management – 99200-99499;
Pathology & Laboratory – 80000-89399,G0001,P0000-P9999;
Radiology – 70000-79999, G0130-G0133, G0236;
Ambulance – A0000-A0999;
Chiropractic Manipulative Treatment – 98940-98943.
Most of these claims were submitted directly by physicians’ offices and not by medical billing firms.

As you are aware, evaluation and management, pathology and laboratory and radiology services are all high volume procedures but with the levels frequency for these procedures the medical billing should be able to be more streamlined for most offices. Your medical billing partner can consult and show you how to reduce and in some cases, eliminate that coding procedures that are causing returns and rejections in your medical billing claims that cause appeals to be filed.

Further analysis by Medicare of the medical billing claims showed that certain factors further contributed to rejected billing:

Required modifiers are not always billed on the initial claims and proper documentation related to the patient’s condition are not always billed on the initial medical billing claims.

Pathology and laboratory services are frequently billed multiple times on the same date without appropriate modifiers causing denials. Your medical billing partner will normally catch these errors, this is another big reason to outsource your medical billing. Laboratory services with frequency guidelines are questioned by Medicare. Radiology is often billed without proper modifiers or correct diagnoses.

Ambulance providers do not usually submit run sheets or additional documentation. Chiropractic claims are also initially billed without appropriate documentation and although developed, often the information is not submitted timely, necessitating an appeals request.

View all Articles by: Melissa Clark, CCS-P