Steer Clear of the Top 5 Reasons for Unexpected Denials
If you are wondering why your practice is receiving an unexpected number of denials for certain codes, you may want to check out a recent study published in Physicians Practice which ranks the top five unexpected denials in various specialties. Data was collected by RemitDATA from May 1, 2014 – May 31, 2014 via electronic remittance claims service lines. Here were some of the results:
Top five most commonly unexpected denied procedures:
- 99213 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity.
- 99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity.
- 36415 Collection of venous blood by venipuncture
- 97110 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
- 99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.
Be sure your claims are filed correctly by avoiding these top five reasons why those codes were denied:
- 18: Duplicate claim/service
- 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication
- 97: The benefit is included in the payment/allowance for another service or procedure already adjudicated
- 96: Non-covered charges
- 29: The time limit for filing was expired
The data also captured the top five most commonly unexpected radiology denials. Code 71010 Radiologic examination, chest; single view, frontal received the most. For more information on the study read “5 Common Medical Practice Denials and Remedies.” May 2014.