Top Denials of Medical Billing

 Tom Jenkins Billing & Collections, Most Recent

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Percentage of Top Trending Medical Billing Denials

Denials Are Preventable 86% of denials are potentially avoidable; only 14% are unavoidable. Nearly one in four potentially avoidable denials (24%) cannot be recovered.

Registration/Eligibility (26.6%):

Coordination of Benefits 41.5%

Benefit Maximum 28.4%

Plan Coverage 23.3%

Other 6.8%

Missing or Invalid Claim Data (17.2%):

Unspecified Billing Issue 73.2%

Missing/Invalid EOB 17.5%

Other 9.3%

Service Not Covered (10.6%):

Service Not Covered 57.7%

Unspecified Billing Issue 22.3%

Managed Care 10.6%

Non-Covered Days 5.2%

Other 4.2%

Authorization/Pre-Certification (11.6%):

Invalid Authorization 61.2%

Authorization Denied 25.9%

Services Exceed Authorization 7.5%

Other 5.4%

Denials in medical Billing

Medical Necessity (6.6%):

Medical Necessity 71.5%

Level of Care 22.1%

Other 6.4%

Medical Coding (4.8%):

Overlapping Services 52.7%

Procedure/ Dx Code Inconsistent with Another Code 18.8%

Level of Care 7.2%

Other 21.3%

We know that 95-100% of non-recoverable denials can likely be avoided. Providers need to implement a denials-prevention strategy for front-end processes that includes staff education and training and the use of advanced technology. This approach can help cut denials dramatically, and in turn, the time and expense associated with appeals, and the risk of lost revenue.

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Over 12 years of experience as an RCM specialist. I have hands-on experience in most parts of the RCM Cycle. Currently designated as Manager – Operations in BillingParadise based out in Diamond Bar, CA. We offer Billing services and Healthcare IT solutions which in turn will improve the cash inflow of the Hospitals and Clinics.

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