How to Avoid "Medically Unnecessary" Medical Billing Denials

There is very little more frustrating in the realm of medical care than to receive a medical billing claim returned and notated with the words of doom for any medical billing claim: “Medically Unnecessary Procedure”. This is frustrating because it essentially means the services were performed for free and won’t be reimbursed by the insurance carrier or Medicare.

There’s little you can do in your practice to ensure that your medical billing claims have proper documentation to show medical necessity of the procedure. ECGs get regular scrutiny for the necessity of the procedure. If your staff is too overwhelmed by the day-to-day business of keeping your patients happy and your practice running smoothly and now your medical billing is suffering as a result and this has a direct impact on the revenue flow for your office.

If you’re experiencing more denials due to medical necessity issues, it is probably a lack of proper coding and proper documentation on the part of your office. A number of these returns could mean it is time to consider outsourcing your medical billing to a company that will make sure each and every claim filed for your practice has the proper coding, documentation and will result in the highest return possible for your practice.

Best of all, outsourcing your medical billing will result in even faster payment on your medical billing claims as all claims are filed electronically.

View all Articles by: Melissa Clark, CCS-P