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How to avoid dirty medical billing claims

All medical billers know how important it is to submit clean claims. A clean claim means your practice gets paid correctly and on time so you can keep your revenue where you want it. In a perfect world, a patient would receive their medical service, a claim would be sent to an insurance provider, and the reimbursement would be returned in a timely manner. But, of course, this isn’t always the case. Billing errors are common, so instead of asking why we can’t eliminate them for good, let’s take a look at the best ways to avoid them. 

What is a dirty claim?

A dirty claim is any claim that contains one or more errors and therefore can’t be processed correctly. A dirty claim could be one that’s rejected, denied, or incorrectly paid. More importantly, it’s something all billers want to avoid as much as possible. With that in mind, let’s take a look at some of the most common billing denials and how you can prevent them. 

The most common medical billing errors (and how to avoid them)

There’s hundreds of different reasons a claim could be flagged with an error, but these are a few of the most common mistakes billers see:

Missing information 

It only takes one missing field to trigger a denied claim. Anything left blank from patient addresses and insurance numbers to billing and procedure codes will result in an unpaid claim. The extra minute or so it takes to make sure all fields are filled out is well worth the time to avoid a denied claim. 

Service not covered by insurance provider

Many practices make the mistake of neglecting to confirm insurance coverage before a medical service is performed. If the procedure isn’t covered under their current insurance plan, the claim will come back in error. 

Duplicate claim or service 

A claim will be denied if two or more identical claims are submitted. This means the claims would contain the same patient and provider and the same service performed on the same date. 

Service already adjudicated 

When a benefit for one service is lumped into the payment for another service that’s already been paid, the claim will be denied because the system will read that the allowance has already been allocated. 

The claims are past their deadline

Insurance companies typically provide a deadline for when claims need to be submitted. If claims are sent in after the deadline, they may be denied. 

Submit more clean claims with Claimgenix

Medical billing software is designed to make your job easier by automating the billing process. Providers who use software to bill insurance claims see far more clean claims than those who are still billing paper claims. Improve your billing process today and book a demo with the Claimgenix team. 

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