List of Common Insurance Denials in Medical Billing - Medical Coding Jobs and Career

Thursday, April 8, 2021

List of Common Insurance Denials in Medical Billing

 List of Common Insurance Denials in Medical Billing

Insurance will deny the claim for some common reason and first we need to understand the Denial fully and we prepare the denial letter and submit the claim with attached all supporting proof. In this post we listed some of the common insurance denial in Medical Billing.

  1. Inadvertent practice errors
  2. Health insurer processing errors
  3. Lack of recognition of "Modifier 25"
  4. Lack of recognition of "Modifier 59"
  5. Health insurer incorrectly down coded CPT
  6. Health insurer applied a PPO discount when a contract does not exist
  7. Medical necessity denials
  8. Request for in-network coverage
  9. Coverage Exclusion or Limitation
  10. Coverage Administration (i.e. copay, deductible, etc.)
  11. Maximum Reimbursable Amount
  12. Inpatient Facility Denial (Level of Care, Length of Stay)
  13. Mutually Exclusive, Incidental procedure code denials
  14. Additional reimbursement to your out of network healthcare professional for a procedure code modifier
  15. Experimental/Investigational Procedure
  16. Medical Necessity
  17. Timely Claim Filing
  18. Benefits reduced due to re-pricing of billed procedures

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