Medical billing denials are the bane of many practice existences. Here are the most common reasons for claim denials.

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Most Common
Reasons for
Medical Billing
Claim Denial

2. Introduction
Most of the time physician practice affected by
medical billing claims denials. To enhance the
physician practice profitability and reduce the
operational costs, you have to reduce the claim
denial rates. Let’s discuss the medical billing
claim denials reasons.
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3. Reasons for Medical Billing
Claim Denial
Incorrect Patient Identifier Information
No Referral on File
Claim Was Filed After Insurer’s Deadline
Missing or Invalid CPT or HCPCS Codes
Lack of Documentation to Support
Necessity
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4. Incorrect Patient Identifier
Information
To make a payment patient identifier information
is plays a major role to identify the patients'
insurance plan.
Other data also cause medical claim denials.
Such as
Incorrect subscriber or patient name
Incorrect subscriber or Patient’s date of birth
Incorrect subscriber numbers
Incorrect subscriber group number
Insurance ineligibility
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5. No Referral on File
If the claim submitted before the primary care
physician‘s referral then the claim gets denied.
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6. Claim Was Filed After
Insurer’s Deadline
Claims need to be submitted before the
deadlines (Timely Filing Deadlines (TFL))
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7. Missing or Invalid CPT
or HCPCS Codes
CPT Codes and HCPCS Codes are used to
identifies the procedures and service rendered
by the physician.
CPT – Current Procedural Terminology
HCPCS – Healthcare Common Procedure
Coding System.
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8. Lack of Documentation to
Support Necessity
For some medical claims processing, the payer
requires an additional document to adjudicate
the claim. Such as
Patient medical history
Patient physical reports
Physician consultation reports
Patient discharge summaries
Radiology reports
Operative reports
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9. About US
MGSI is the leading medical billing company in Florida US. We
provide various services such as
Cardiology Medical Billing
Radiology Medical Billing
AR Follow up
Denial Management
Medical Claims Processing etc.
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10. Do you have
any queries?
info@mgsionline.com
www.mgsionline.com
1-877-896-6474
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