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How to Avoid Rejected Medical Claims in the Future

Crafting accurate, complete, and timely medical claims is essential if you want to be reimbursed for your services. But submitting a rejected claim can take time, cost money, and damage relationships with insurers or clients. To ensure the best chance of your claims being accepted, use this guide to avoid rejected medical claims.

Know Your Coverage

It’s essential to understand your coverage policies and if any changes have been made. Knowing the rules and requirements for submitting medical claims can help you avoid costly mistakes. Make sure to review the policy of each insurer before filing a claim. Additionally, contact the insurance company directly if you have any questions or are uncertain about their requirements.

Use Codes and Descriptions Accurately

Medical claims are rejected due to inaccurate coding or descriptions. Make sure you use the most current and accurate codes, including procedure codes and diagnosis codes. The insurance company will not pay for incorrect coding - even if it’s only a minor error. Double-check that your codes are up-to-date, accurate, and complete before submitting any claims. Hiring us as a code auditor would be a good solution to this.

Cross Check Your Claims Against Established Rules

Each health insurance company applies its rules and regulations to determine if a claim is covered. These often vary by plan type and may change annually. For example, in some cases, preventive services can be billed with different codes than those for treatments or diagnostic tests. Be sure to carefully read the plan’s policies before submitting a claim to ensure all appropriate codes are included. A good Practice Management Service can verify this info for you.

Double-Check Credentials and Contact Information

Filling out the paperwork correctly the first time is critical to avoid rejected claims. Double-check that the patient’s information, such as name and date of birth, is correct and up to date. Additionally, ensure all necessary contact information like address and phone number are accurate and legible on the forms. If any discrepancies arise, you may run into issues with your submissions and likely won’t receive payment on time or at all. Sending your claims to a claims scrubber or clearinghouse can double-check for possible errors.

Follow Up on Submitted Claims Quickly

To prevent rejected claims, follow up on any submitted paperwork promptly and consistently. This ensures that in the event of any issues or mistakes with your claim, they won’t go unnoticed. Check back on your submission frequently to ensure it’s still in process and that you haven’t overlooked an issue. Timely follow-up will help identify any problems with a claim early on so they can be addressed before the payment is issued. We will make it our priority to give you information and updates when they arise.

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