{"id":15265,"date":"2015-02-24T18:13:34","date_gmt":"2015-02-24T23:13:34","guid":{"rendered":"http:\/\/blog.carecloud.com\/?p=15265"},"modified":"2015-02-24T18:13:34","modified_gmt":"2015-02-24T23:13:34","slug":"top-reasons-physician-practices-see-unexpected-claim-denia","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/top-reasons-physician-practices-see-unexpected-claim-denia\/","title":{"rendered":"Top Reasons Physician Practices See Unexpected Claim Denials"},"content":{"rendered":"<p>Seeing more than your fair share of denied medical claims?<\/p>\n<p>Increase the chances your medical practice will keep more of the revenue you earn by focusing on 5 commonly denied procedure codes \u2014 and the reasons driving the denials.<\/p>\n<p><!--more--><\/p>\n<p>Analysis of electronic remittance claims submitted in the final 3 months of 2014 reveals the most commonly denied procedures:<\/p>\n<ul>\n<li><strong><strong>\u2018Outpatient doctor visit, level 3\u2019 (CPT code 99213)<\/strong><\/strong><\/li>\n<li><strong><strong>\u2018Outpatient doctor visit, level 4\u2019 (99214)<\/strong><\/strong><\/li>\n<li><strong><strong>\u2018Routine blood capture\u2019 (36415)<\/strong><\/strong><\/li>\n<li><strong><strong>\u00a0\u2018Subsequent hospital care\u2019 (99232)<\/strong><\/strong><\/li>\n<li><strong><strong>\u2018Therapeutic exercises\u2019 (97110)<\/strong><\/strong><\/li>\n<\/ul>\n<p>Family medicine, internal medicine and pediatrics essentially tied for specialties with the most unexpected denials at 10% each, according to this study from <a href=\"http:\/\/remitdata.com\/\"><strong>RemitDATA<\/strong><\/a>. Radiology and orthopedic surgery followed closely behind.<\/p>\n<h4>Beware the Bundle<\/h4>\n<h4>Denial reason codes include:<\/h4>\n<ul>\n<li>\u201cDuplicate claim\/service\u201d tops the list of reason codes behind the most commonly denied procedures (reason code 18)<\/li>\n<li>While bundling services may save you money on your cable bill, bundling your CPT codes could cost you. Unexpected denial caused by coverage within a bundled service \u2014 officially known as claim adjustment reason code 97 \u2014 was the #2 reason for claim denial, according to a <a href=\"http:\/\/www.physicianspractice.com\/medical-billing-collections\/5-common-medical-practice-denials-and-remedies-fourth-quarter-2014?GUID=5D7DE5D2-33BE-41C1-BFB1-31ED8BDD95D2&amp;rememberme=1&amp;ts=17022015\"><strong><em>Physicians Practice<\/em> infographic <\/strong><\/a>of the study results.<\/li>\n<li>Lack of information or medical billing error (reason code 16)<\/li>\n<li>Non-covered charges (code 96)<\/li>\n<li>Care possibly covered by another payer (code 22).<\/li>\n<\/ul>\n<p><strong>Using the right modifier<\/strong> can boost your medical revenue cycle by helping to avoid claim denials, especially to justify a distinct procedure typically billed within a bundled service.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Seeing more than your fair share of denied medical claims? Increase the chances your medical practice will keep more of the revenue you earn by focusing on 5 commonly denied procedure codes \u2014 and the reasons driving the denials.<\/p>\n","protected":false},"author":1,"featured_media":31521,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,69],"tags":[131,213,214,53,215,39,85],"class_list":["post-15265","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue","category-show","tag-claim-denials","tag-cpt-codes","tag-denial-reason-codes","tag-medical-billing","tag-medical-claims","tag-revenue","tag-revenue-cycle-management-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Top Reasons for Unexpected Medical Claim Denials<\/title>\n<meta name=\"description\" content=\"Boost your medical revenue cycle returns. 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