February 2014 Medical Claim Data: Most Common Denials and Remedies

March 21, 2014

RemitDATA's director of product management, Aaron Hood, explores the most common unexpected denials at practices nationwide, with a focus on family medicine.

The data represented was collected from electronic remittance claim service lines between Feb. 1, 2014, and Feb. 28, 2014.

The top five denied procedures for February 2014 once again reveal that denied visits continue to be a problem. Three of the five most frequently denied procedures were related to visits - E&M office visit procedures 99213 and 99214 coming in first and second with hospital visit code 99232 in fifth. The third most denied procedure went to usual seasonal suspect 36415 (routine blood draws) with 97110 (therapeutic procedure) coming in at number four.

The top five denial reasons continue to weigh heavily on adherence to payer rules when forming and submitting a claim (including duplicate claim/service and claim lacks information or has errors). New for February is the rise of code 109 (not covered by this payer/contractor) to the number five spot on the rankings. These process-related issues can be relatively easy to solve with additional training, enhanced compliance management, and pre-submission payer/contractor confirmation.

The top five unexpected denial reasons for family medicine highlight the lack of adherence to payer rules when forming and submitting a claim (including duplicate claim/service, claim lacks information, has errors, or timely filing). Again, these process-related issues can be relatively easy to solve with additional training, enhanced compliance management, and pre-submission payer/contractor confirmation.