Week 4 IHMO Assignment
Three Reasons for Claim Returns
What are some causes for insurance claims to be returned? One of the main reasons for returned claims would be because the patient did not have coverage at the time the services were rendered. This is a very common reason that claims are returned. This meaning that the patient was seen either before coverage began or after the coverage had ended. Now a lot of insurance companies are putting the date coverage started on the insurance card to cut down on the number of claims being returned for this reason. Another reason is a non-covered procedure. This is a very common reason for return of claims too. All insurance companies have different coverage dependent on the policy that the patient has. Most policies cover things such as well check exams, sick visits and common things like this but when it comes to more specific visits, each policy can differ on what is covered or not. So a lot of practices may get prior approval for a procedure before doing the procedure. This helps to keep the loss of money down in a practice and insures them that they will be paid for the procedure. Another reason a claim could be returned incorrect patient identifier information. This could range from several different things such as patient’s name is spelled incorrectly. The patient’s date of birth doesn’t match the insurance company. Also, the subscriber number is missing or the patient’s group number could be missing or invalid. These are just a few reasons why insurance claims could be returned, which is why it important to make sure the correct information has been entered and verified when possible.
Hicks, J. (2015). Top 10 Reasons Claims Get Denied. In About.com. Retrieved April 11, 2015, from http://medicaloffice.about.com/od/denials/tp/Top-10-Reasons-Claims-Get-Denied.htm Healthcare Claim Processing Errors. (2015). In...
References: Hicks, J. (2015). Top 10 Reasons Claims Get Denied. In About.com. Retrieved April 11, 2015, from http://medicaloffice.about.com/od/denials/tp/Top-10-Reasons-Claims-Get-Denied.htm
Healthcare Claim Processing Errors. (2015). In All-Things-Medical-Billing.com. Retrieved April 11, 2015, from http://www.all-things-medical-billing.com/healthcare-claim-processing.html
Centore, A. (2011, February 18). 17 Reasons Why Your Insurance Claims Are Being Denied. In Thrive Works. Retrieved April 11, 2015, from http://thriveworks.com/blog/17-reasons-why-your-insurance-claims-are-being-denied/
Please join StudyMode to read the full document