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Ppt for Medical Billing Star

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Medicalbillingstar is one of the leading firm in california which provides medical billing services like medical claim processsing,medical billing and coding,AR follow ups services,EMR support services visit us @http://www.medicalbillingstar.com/ dial 1-888-571-9069

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Page 1: Ppt for Medical Billing Star

Top 8 Denial Reasons

Page 2: Ppt for Medical Billing Star

Top 8 Denial Reasons

Classification DescriptionAction that is taken by the Medical Billing Star

Claim not on file

(Medical Billing Star responsibility)

In most cases the claims sent out to local insurance companies by paper are the ones that need to be resubmitted as the Insurance companies do not have the initial claims that are sent. billing office ensures that all unpaid claims are called and checked with the respective insurance companies within their filing limits.

Medical Billing Star already follows up on these claims and ensures that the claims are resent within the filing limits

2

Additional Information

(Provider/Patient responsibility)

Insurance companies require separate documentation like, Primary insurance company’s explanation of benefits, the coordination of benefits from the patient, accident details etc .

The billing office ensures that the primary insurance companies EOB is sent out to the secondary Insurance company. All other requests for further information is forwarded to the Patients by statements

3

Patient responsibility

(Patient responsibility)

This is normally the case when patient is billed for the payments as they lack an insurance plan and these claims are kept open until we receive payments from the patients

Medical Billing Star ensures that all payment statements are sent across to the patients in a timely manner

4

Patient not valid

(Provider responsibility)

This is normally the case when the patient has a insurance plan which has termed before his date of service and so the payment statement is sent out to the patient for payment

Medical Billing Star ensures that all payment statements are sent across to the patients with an explanation that their plan has been terminated and that they would have to get back with valid insurance information

5

No Authorization/Referral#

(Provider responsibility)

The provider for certain procedures gets an approval or authorization number from the insurance company before they go ahead. In most cases the authorization number is not mentioned by the provider’s office in the documents sent over to the billing office. Insurance companies deny claims for these certain procedures on these grounds

Medical Billing Star gets back to the provider for information about the authorization number that they should have received. If they get the required info, the claim is resubmitted to the Insurance company

Page 3: Ppt for Medical Billing Star

Top Reasons …

Invalid CPT code/ Dx code

(Medicalbillingstar responsibility)

Insurance companies have an approved list of

procedure/diagnosis combinations that they would pay

for. Medical billing star maintains a database of the

approved combinations by different insurance

companies. Our experienced coders ensure that the

highest paying approved combination of procedure and

diagnosis codes are used to ensure maximum payment

Medical billing star already follows up on the

these claims and ensures that CPT/ICD

codes are corrected as per the respective

insurance companies and resubmitted within

the filing limits

Mutually Inclusive

(Medicalbillingstar

responsibility)

Modifiers are required for certain claims to be able to tell

the insurance company that the procedure billed for is a

revaluation based on a previously billed procedure code.

These are reworked by the billing offices and

resubmitted within the filing limits

Medicalbillingstar already follows up on

these claims and ensures that the necessary

modifiers are included and the claim is

resubmitted within the filing limits

Services not covered

(Patient/Insurance company’s responsibility)

This is when the patients insurance does not cover the

procedure performed by the doctor and in most cases

the payment statement is sent out to the Patient

Medicalbillingstar ensures that all payment

statements are sent across to the patients

with an explanation that the services that

were charged to the insurance company are

not covered for their plan

Page 4: Ppt for Medical Billing Star

*approximate values, based on 40% of the charged values

Over a 5 month period with our existing clients.

Sl No Categories # of issues Charged amount Amount Received

1 Claim not on file 205 14284.8 5713.9

2 Invalid CPT code/ Dx code 17 4196.8 1678.7

3 Mutually Inclusive 16 1229.3 491.7

4 Additional Information 200 24614.3 9845.7

5 Patient responsibility 96 10438.7 4175.5

6 Services not covered 36 9610.9 3844.3

7 Patient not valid 61 3054.9 1222.0

8 No Authorization/Referral# 49 6407.3 2562.9

    680 73837.0 29534.8

Page 5: Ppt for Medical Billing Star

Denial Reasons - # of issues

17, 3%

16, 2%

96, 14%

36, 5%

61, 9%

49, 7%

205, 31%

200, 29%

Claim not on file Invalid CPT code/ Dx code Mutually Inclusive Additional Information

Patient responsibility Services not covered Patient not valid No Authorization/Referral#

Page 6: Ppt for Medical Billing Star

Denial Reasons – Amount Received

5713.9, 19%

1678.7, 6%

491.7, 2%

4175.5, 14%

3844.3, 13%

1222.0, 4%

2562.9, 9%

9845.7, 33%

Claim not on file Invalid CPT code/ Dx code Mutually Inclusive Additional Information

Patient responsibility Services not covered Patient not valid No Authorization/Referral#

Page 7: Ppt for Medical Billing Star

Medicalbillingstar also maintains an internal database of rejected

and underpaid claims of various carriers to serve as an expeditious

source of reference for similar cases in the future. This drastically

cuts down our denial management time-frame and puts the money

where the mouth is, i.e. the physician’s pockets