Medical Billing Blog: Section - Denials

Archive of all Articles in the Denials Section

This is the archive containing links to all articles written in the Denials section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

Multi-Day Observation Claims Don’t Have to Mean Rejections

Confused about multi-day observations? Well, you’re not along. Multi-day observation medical billing claims can cause a lot of confusion. In order to get the correct reimbursements on your medical billing claims, you need to be sure that your multi-day observation billings are reported correctly – otherwise you’re practice isn’t receiving the maximum reimbursements for the services rendered and you’re in effect – losing money. A main rule of thumb when doing medical billing for multi-day observation is to report per day of service. This means that if a patient is admitted late at night and isn’t discharged until the next morning, you report both service dates. The two current procedural

By: Melissa Clark, CCS-P, RT - CEO
No Comments

Ending Confusion Over 99000 Series Codes in Your Medical Billing

There were two new codes issued in 2006 that continue to confuse many medical billers still over halfway into 2007. These two codes were created to specifically address the after-hours and red-eye services for procedures done by physicians outside the normal hours. Previously when compiling the medical coding for medical billing, a coder would have used 99050 as a “catch-all” coding. Now CPT has revised the original code and added new codes. 99053 is ” “for services between 10 p.m. and 8 a.m. in 24-hour facilities,” and will be used by both physicians on call and hospitals. Please note that code 99053’s wording to include “24-hour facility” will put a

By: Melissa Clark, CCS-P, RT - CEO
No Comments

Oh, Those Feelings of Rejection!

When your medical billing claims get rejected, one claim can put your staff behind on everything they are supposed to be doing. The patient’s folder will have to be pulled, the notes will have to be re-read and researched, the claim will have to be compiled again and the coding will need to be double checked again to make sure you are using the latest codings and modifiers for the claim. In some cases the carrier will need to be contacted which is more time lost from servicing your practice and the claim will have to be submitted once again and the will take more time away from your day

By: Kathryn Etienne, CCS-P, RT - DOO
No Comments

A Common Reason for Rejection

One way that many medical billing claims get rejected for the smallest of errors. In many cases it can be something as simple as an incorrectly used modifier causing your claim to be rejected by the carrier. There are two modifiers that get a lot of people in to trouble in the form of rejected claims as they can be confusing and those are modifier 25 and 57. Modifier 25 which reads , “Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service” is kind of a catch all modifier for procedures that may not have an exact coding

By: Kathryn Etienne, CCS-P, RT - DOO
No Comments

Why Medical Billing Claims Get Denied?

There are a number of reasons that your medical billing claims could be getting kicked back. Next time you have a medical billing claim kicked back, carefully check it to see why it was returned. Finding out why your medical billing claims were refused will sometimes uncover an unhealthy pattern in your office such as not keeping up with the changes to the CPT codes. And that’s our number one reason, usage of outdated or improper codes. The CPT updates a number of times a year and keeping up with those changes can be difficult. However, if you don’t use the most current coding the carriers are well within their

By: Kathryn Etienne, CCS-P, RT - DOO
No Comments

Avoiding Costly “Medically Unlikely Edit” Denials

It can happen to any individual who is involved with coding, dealing with MUEs can end up being a nightmare if you do not know when and how to use them. MUEs, which is short for the term Medically Unlikely Edits, happen to be put in place to try and help limit the amount of billing errors. The more you understand them, the better off you will be when you find that you need to use them. If you are worried about dealing with MUEs, then you really should know that you are not alone. Luckily, there are a couple of things that you can look to and keep in

By: Kathryn Etienne, CCS-P, RT - DOO
No Comments

Getting Rid Of Denial Claims For Well Visits

You should always pay good attention to what payers are perceiving when looking at your medical billing. Even though your practice may view the coding procedures a certain way, it is not always the case that your payer will understand them in the same fashion. It has recently been shown that there is a major discrepancy when it comes to dealing with the billing of the procedure code 96110. The fact is that this procedure code should never be lumped in with well exam codes, except for special circumstances. What can actually happen to cause problems is that the miscommunication between medical billing for your practice and the payers are

By: Melissa Clark, CCS-P, RT - CEO
No Comments