July 12, 2020

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medical billing

4 Major Obstacles between Successful Medical Billing Claims!

The revenue cycle of the medical provider is run by a smooth medical billing and coding procedure. It can cause many financial problems if not dealt with attention. The providers should catch the errors and mistakes ahead of submitting claims to remove the obstacles between successful reimbursement payments. For this reason, the providers can avail the medical billing services in the USA. Following some significant hitches between successful medical billing is illustrated!

medical billing

  1. Incomplete Information

Incomplete information can merely end up with claim denials or rejection. Even if the providers need to get their claims paid on the first attempt, they should ensure that even the small mistakes need to be correct and authentic to submit the claims. The billers need to take care of the simple data of the patients while entering the information in the claims form. They should take care to enter the correct spellings of the name, gender of the patient should be mentioned, and a valid policy number should be written. The denied claims due to incomplete information can be submitted again. It can take a long time to get paid. Generally, within 14 days, the claims are reimbursed. However, the denied claims due to inaccurate and incomplete information can take 40-45 days to get paid.

  1. Duplicate Claim Submission

A duplicate claim is a claim made for the procedure, test or treatment more than once. Usually, duplicate claims are submitted due to human error. However, such claims are also made with intention and result in fine and punishment. It is a severe situation and a major obstacle between successful reimbursement payments. The medical billing and coding experts should try to carefully submit claims and so they don’t need to send them again. The experts can perform chart audits. The chart audit will assist them in making sure that all parts of the claims are billed correctly. There are many reasons behind duplicate billing which are written below:

  • Service or treatment charged twice
  • Claim submitted again to avoid untimely filing submission
  • Payment has been made but not posted
  • The procedure was performed more than once in a day


  1. Services Not Covered by the Payer

There are many reasons which hinder the successful payments. It happens that the patient gets the treatment services but those services are not covered under the insurance coverage of the patient. It is also one of the reason due to which the claims get denied. The physician needs to be very careful before treating the patient that whether the patient’s treatment is covered by the insurance company or not. There may be several reasons behind the non-coverage of the particular treatment of the patient by medicare, medicare or insurance provider. They are mentioned below:

  • Non-covered services under the insurance policy
  • Unreasonable and unnecessary treatment services by the provider
  • Services included in the basic allowance of another service
  • Time limit for claim submission already passed
  1. Time Limit for Claim Submission is Over

The medical biller and coder needs to follow CMS guidelines to submit the claims. The insurance providers have prescribed certain time limits within which the biller has to make claims for successful reimbursement payments. Typically, the claims should be sent within 40 to 60 days of the services to get the payments in 14 to 15 days. However, if the time limit is exceeded, then the claims can be reimbursed in 40 to 50 days which is an extended period. The untimely claims can also get denied. The provider can appeal it, but it is a lengthy procedure, and not the best option to pursue.

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