Denied claims are an unfortunate reality in the world of medical billing, but that doesn’t mean that you shouldn’t strive to fix as many issues as possible before sending the claim in the first place. According to AAPC, the number one reason that claims get denied is that the biller forgot to check the insurance verification before sending in the paperwork. Thankfully, this problem has a simple fix that will get matters back to running smoothly in no time.
Though there are numerous recurring problems with insurance verification, three specific issues pop up more often than the rest. They are:
- The patient was not eligible for coverage on the date a service was provided
- The patient’s insurance does not cover a specific procedure
- The service provided did not receive the proper preauthorization ahead of time
As with many common errors, these causes for denial can be easily remedied by double-checking all the pertinent information before submitting the claim. A few days before a scheduled appointment, call to ask patients if they have had any change in insurance and, if so, get their new ID numbers so you can check the details of their new policy (specifically their coinsurance, copay, deductible info, and the end date of coverage). Don’t rely on the patients to provide all these details, as many times they will not know themselves. Additionally, it helps to be familiar with common diagnoses and treatments, as well as how the major insurance carriers reimburse each one. Though there is no way to know exactly how a patient encounter will go, committing the frequently-seen issues to memory will make it that much easier to look them up and confirm that they are covered by a patient’s policy. Finally, in the case of preauthorizations, it helps to establish a policy in which you do not even attempt to file the claim unless the preauthorization number is included.
Though these steps may seem like a hassle in the already busy day of a biller, the truth is that catching insurance verification errors ahead of time is always better than having to sort them out later. Even if it takes a few extra minutes to confirm that a claim has all the elements necessary for proper reimbursement, it will save you the much larger frustration of having to sort back through the claim again in the future.