Claim denials?

We will use Medicare as an example but this could apply to Medicaid or other third party insurance companies as well

Medicare claims get denied mainly for the following reasons

Incorrect or missing ICD-9 diagnoses

Incorrect or missing CPT-4 modifiers

Duplicate claim

Additional information needed to process the claim

Claim billed amount incorrect

Incorrect or missing CPT procedure code

Physician's name and/or UPIN missing or incorrect

Incorrect or missing place of service code

Incorrect or missing quantity of services (Service billed without "quantity" noted, or with multiple quantities indicated in error on claim)

Services inappropriately bundled

As you can see, some of the main reasons for claims denials is incorrect/incomplete data entry and incorrect medical coding

AAPC-certified medical coders know the ins and outs of both diagnostic coding and procedural coding

Handling CPT and HCPCS coding. We code for surgery, lab and other tests based on the guidelines of AMA and CMS

We also do ICD coding related to the CPT and HCPCS codes based on AMA and CMS guidelines. Read more about our medical coding services