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Why are your Medical Billing Claims Denied?

Nov 19

Claims denials not only affect your cash flow but also the relationship with your patient is also severely affected. Although the denied claims can be successfully appealed, their status often remains uncertain, and this is something that your patient and practice would most probably like to avoid.  In a healthcare management system, an increase in claim denials is caused by many factors. It is without a doubt understandable that no matter if it’s the provider’s or the payer’s fault, the rejections happen because the medical billing and coding process is a complex one, and in order to reduce claim denials, ensure that claims are filed on time, and the information of the patient is documented correctly. For this purpose, you can always go for outsourcing medical billing services or can work closely with your in-house medical billing services. 

Why prevent Medical Billing Claims Denied?

Denial prevention is very important. This is because if you prevent a denial before it leaves your healthcare practice, your practice’s profitability and revenue cycle will accelerate. If your practice has dealt with denied claims or an appeal process, your cash flow and administrative costs will see a lot of decreases. Therefore it is good to find solutions or outsource medical billing services in order to minimize denial rates. 

Most common reasons that claims are denied:

The key point to prevent claim denials is understanding its most common reasons. Here are some of the most common reasons that can cause denied claims:

No or expired preauthorization

One of the foremost steps in the RCM process is prior authorization or preauthorization. Patient insurance providers often require prior authorization for numerous healthcare procedures. An insurance claim that is not previously authorized often gets rejected and is called an unauthorized claim. There is also some preauthorization that comes with an expiration date. If the claim is made after that date, it will be denied by the insurance company.

Claims are not filed on time

In order to be submitted and considered for payment, every claim is provided with a specific time limit. If one fails to submit the claim before the due time, the practice will be responsible for paying the price of the procedure on its own. Healthcare providers often miss filing claims on time. This is because of lost or incomplete bills known as charge tickets. The claims are denied despite being correct if filed after the date has passed. You can improve this by getting medical billing services from a third party.

Incorrect billing codes/modifiers:

Humans are bound to make mistakes. Therefore, the staff of the medical center sometimes makes errors by entering an incorrect billing code or using the wrong modifier. This incorrect or incomplete code or modifier results in denied or rejected claims. It is important to catch and resolve these mistakes, or else the practice will have to handle many unpaid insurance claims. Sometimes the practice is unaware of the changes in codes and keeps on using the old versions, which eventually causes denied claims. In order to stay updated, try outsourcing medical billing

Inaccurate insurance ID number on the claim

The practice is responsible for verifying whether the patient’s immediate information is up to date upon every visit. This also includes the changes that occur in their insurance plans as well. The insurance company or the payers now do not recognize or validate old ID numbers or old insurance cards of the original claim. Medical coding and billing may also get affected if the patient data is entered manually via untrained staff. If you want experts to do your billing and coding work, outsourcing medical billing services is the best solution for you. 

Inconsistent data

If the data on a claim is entered incorrectly, it often denies the provided services and procedures. Discrepancies may occur due to several reasons. This may include wrong documentation of gender-specific conditions or the entry of inaccurate information. In order to minimize inconsistent data, a practice may opt for an alert system or think about outsourcing medical billing. By doing so, the claims with errors would not be processed and denied saving a practice’s money and time. 

Upcoding or unbundle

When a practice uses billing codes in order to get more payment for a procedure than what was actually performed is known as upcoding. Whereas when the services that should be billed together are being billed separately is known as unbundling. Upcoding and unbundling both cause claim denials.  

Claim duplication

Claim duplication is a very common mistake that should not happen. If a claim is submitted for the same patient for the same treatment from the same provider, then this claim would be called duplicate and will be denied. Claim duplication occurs mostly because of problems in your workflow.

In order to reduce the denial percentage of your claims, go for outsourcing medical billing services. This is because they have trained staff who know how to bill and code without causing errors and resulting in claim denials. 


An increase in claim denials occurs because of many reasons. If your practice has also increased the rate of claim denials, then outsourcing medical billing is what recommended. Getting medical coding and medical billing services from a company that has many experts can find and solve the issues that result in claim denials.  UControl Billing is one of the top medical billing coding companies in the USA. They have a team of highly-trained medical billers and coders. Their professionals have the up to date information, and they use the most advanced coding in order to increase revenue and decrease claim denials. UControl Billing provides medical coding and billing at the most affordable prices in order to keep your practice running efficiently.

Get started today and contact UControl Billing medical coding and billing experts now in order to decrease your claims denials right away. For more information regarding the medical billing services provided by UControl Billing, click on the attached link and visit their website.