Claim Rejection Research Paper

Medical coder and biller have as a goal to make sure that the provider that they work for gets their reimbursement for all their services. Unfortunately is common to incur in some human and electronics errors while submitting the claims. These errors would prevent the insurance companies from paying the bills, rejected it and returned it to the biller, so the claim can be corrected and resubmitted. Bellow I will explain some common errors of claim rejection.

INCORRECT PATIENT INFORMATION

These errors occur when the claim submitted has errors related to patient demographic data as their right age, miss spell name, wrong date of birth, incorrect gender, previous address or wrong address, also when the patient policy number is not the right one

or the number has been modify as well as any information missing on the patient portion of the claim.

INCORRECT CODE, MISSMATCHED OR LEAVING OUT CODES
These type of errors happen when there is not diagnostic code on the claim form, the code submitted is not valid, the code do not match with the procedure or treatment provided, when the code entering has to few or to many digits, when there is a confusion entering the codes, the place of service code is missing or is not the correct one. These types of errors are one of the most usual errors why the claims can be returned.

DUPLICATE BILLING
These occurs when some of the persons in charge of the billing at the provider’s office submit a claim without checking if the service or procedure has been submitted already or if it has been paid. Errors like these can be a real problem for billers and for the insurance company as well, because it will look like the patient has received the same service or procedure twice, and this will make the amount sent out to be double.

These errors above are some of the most frequent errors that a medical biller can come across; these errors would affect the status of a claim and can also delay provider’s reimbursement. That is why billers and coders need to be well trained and be up to date with any code’s changes, improvements or change in protocols. Is also important for them to double check and revise the information when a new claim is created and before is submitted. This type of action will make a difference between an approved or retuned claim.