Claim Denials Expected to Increase

Claim Denials Expected to Increase
Claim Denials Expected to Increase

(HealthDay News) — Even with good office procedures, most practices are plagued by claim denials, a hassle that is expected to increase in the coming years, according to an article published May 8 in Medical Economics.

The author of the article, Susan Kreimer, notes that research by the American Medical Association (AMA) shows that insurers' claim denials averaged 1.82% in 2013. These rates are expected to increase substantially following the conversion to the International Classification of Diseases, 10th Revision (ICD-10) billing codes. The Centers for Medicare & Medicaid Services estimates that, in the early stages of ICD-10 coding, claim denials may increase 100–200%.

Medical Economics has compiled a list of common reasons for claim denials and encourages practices to train office staff to submit clean claims. Some common mistakes include: submitting a duplicate claim; the patient hasn't met the annual deductible or has exceeded a specific benefit; some services are bundled; lack of medical necessity; no pre-authorization; filing deadline has passed; or there are mistakes on the form (i.e., missing a modifier or inconsistent place of service listed).

"Although the AMA has advocated for a standardized system, insurers continue to hold on to their complex proprietary rules that create a variety of paperwork bottlenecks," Ardis Dee Hoven, MD, president of the AMA, told Medical Economics. "We must move toward an automated approach for processing medical claims that will save precious health care dollars and free physicians from needless administrative tasks that take time away from patient care."

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