If you are able to understand the reasons as to why the medical bills might be denied, it will certainly be easier for you to reduce the number of these bills. If the medical bill of a particular bill is denied, it is enough reason for him or her to fall sick.
Therefore a health care organization that denies medical bills will also have lower revenues because clients will find it difficult to trust such an organization.
There are however certain denial codes in medical billing that will actually help you to get a proper understanding as to why the medical bills have got denied. Most common reasons for denial of the medical bills include billing errors, lack of patient information, etc.
If you want to know more about the reasons for denial of medical bills, you can go through the points mentioned below:
- If there are certain non covered charges
If the medical procedure that was undertaken was not covered under the medical policy, your medical bills will surely be denied. So before getting a policy make sure that you go through the categories that are covered under medical insurance.
- Choosing a medical provider that does not fall within the network
In case you choose an insurance company that has certain health organizations under its network and only if you go through those organizations, you get the medical bills paid, for all certain cases make sure that you choose an organization that falls within the network. If not, your medical bills might get denied. Denial management in medical billing is however very important for all medical organizations to increase the revenue.
- Receiving 2 services in one single day might be a reason for the denial of the medical bill
Most insurance companies have a ” one service per day” policy and this means that even if a particular patient has 12 sessions authorized for a therapy and if the patient undergoes 2 sessions in one day, the medical bill for just one session would be accepted and the other would be rejected. However, this is not the case with all health issues, it is mostly true for the behavioral health issues.
- If the authorization times out, even then the medical bills will be denied
The authorizations are for a certain number of sessions and they are also there for a particular duration. Sometimes the time span might be as short as 30 days. If services are provided to you after the expiration of the authorization, then the medical bills will be denied.
- If the patient is late to pay in COBRA
In case you lose your job, you can keep your health insurance, in COBRA which is a government program. However, in such cases you have to pay the full 100 percent of the principle amount of the policy. In case you have missed paying COBRA, then chances are that your medical bills might get denied.
Medical bills can get denied for the reasons mentioned above, so make sure that you keep these points in mind when presenting your bills.
