How to deal with rejections
Rejection can come in many forms. Regardless of the source, it’s never a great feeling. Now imagine that rejection occurring before you even leave the house.
In the world of medical billing and coding, this happens often. It can be absolutely maddening trying to resolve these rejections, but all is not lost! We are here to help you get past those irksome rejections - ensuring your claims can make it promptly to insurance for processing.
The first hurdle to jump is to determine exactly what the rejection reason is. Sometimes it’s something as simple as the patient’s name was entered incorrectly. Here is a quick way to narrow down some common rejection mistakes:
Verify the spelling of the patient’s name - including any hyphens. The name on the claim must match the patient’s insurance card exactly.
Confirm the correct insurance coverage is attached to the claim being sent.
Verify the insurance information is accurate and the policy is still in effect.
Check for any issues with the insurance company or plan information entered into your practice management system. Something as simple as a an incorrectly formatted insurance mailing address will hold up all claims associated with that insurance.
Pay attention to where your claim is going. For example United Health Care has claim processing locations in both Salt Lake City and Atlanta. Check the back of the patient’s card to verify the claim address.
Confirm the insurance is set up to accept electronic claims.
If billing any drug codes, confirm that the NDC has been added in the correct 5-4-2 format, along with the description for any unspecified drug codes.
Check your codes! It’s easy to over look a coding error if you are not coding the claims yourself. Most software systems offer a claim scrubber to ensure all codes meet the minimum requirements and reflect the procedure code use. Imagine billing the assigned dx code E29.1 with a vaccination code. It is incorrect!
If you got through this list and are still stumped, never fear! Most reputable practice management systems will have a rejection guide available to help you work through additional rejection issues.