Top 3 Types Of Appeals Filed In Your Medical Billing Claims

Top 3 Types Of Appeals Filed In Your Medical Billing Claims

Filing appeals for your denied medical billing claims is never a fun affair.
In many cases, these denials of claims could have been avoided completely with just a little bit of preparation with your medical billing claim.

The number one type of appeal filed on medical billing claims was on claims denied due to diagnosis reasons. This can be due to incorrect coding, under or over coding and the biggest offender in this category dealt with medical billing claims that were coded using outdated codes. The ever changing world of diagnosis codes is not easy to keep up with in a busy practice, hence another reason you should seriously consider outsourcing your medical billing if you aren’t already.

Medical Necessity was another reason for appeals being filed on denied claims and lack of medical necessity was determined because of a lack of documentation supporting the diagnosis on the medical billing. Your medical billing partner makes sure that you have proper documentation before the claim is submitted and therefore you realize a marked decrease in denied and partially paid claims just because of this one action.

Your medical billing partner can also recommend small methods on many levels of your medical billing and coding that will save you time and money in the form of no denied /partial payments on medical billing claims meaning your staff won’t have to be constantly looking up and noting patient files.

Non covered Services is a hard appeal to file. If you truly believe the medical billing should have been covered by Medicare or the carrier – fight it.Check your coding and make sure you have the documentation to prove your case.

View all Articles by: Melissa Clark, CCS-P