Struggling With Denied Medical Billing Claims?
Medical Billing Claim denials happen when an insurance company refuses to pay or process a claim due to a many factors including errors, lack of information, or deviation from best billing policies. These denials result in sporadic cashflow cycles, reduced revenues, and other administrative burdens for healthcare providers.
Even if a medical practice perfectly follows best billing practices, claims can be denied. It’s a medical billers job to follow up on these denied claims, aka appeal the decision, and help clarify so insurance companies can process the claim correctly and payout the bill. Of course, proper billing systems in place will minimize denied medical billing claims, resulting in an overall smoother revenue cycle for your medical practice.
At CBS Medical Billing and Consulting, we specialize in clean claims. Over the past 15 years, we’ve earned a reputation for maximizing reimbursements and mnimizing claim denials. We also go to battle for our partners, appealing denails until insurance companies make it right. Through our medical billing services (like medical claims scrubbing), medical practices can find innovative solutions for their billing and administrative woes.
But enough about us. Keep on reading this blog to learn about some of the most prominent causes of denied claims, and see if any of these high level solutions can help!
Main Reasons for Denied Medical Claims
Billing Mistakes
Even the slightest mistake in medical coding can cause claim denials. CBS Billing experts conduct coding audits and compliance checks in order to ensure that denials are minimized and accuracy in billing is maintained. Errors made including:
- Incorrect usage, or failure to update, ICD-10, CPT, or HCPCS codes.
- Unbundling, where specific service(s) are paid for as if they are done independently, whereas, they are supposed to be done together.
- Specificity issues which result in diagnosis codes lacking detail, ending in claim rejection.
- Upcoding where services rendered are charged to be higher than what they actually were or undercoding where charges incurred are lower than the services rendered.
Difficulties resulting from claim denial are minimized when accuracy of coding is maintained. Head of CBS Billing coding audits conducts specialists that recode to ensure compliance thus destroying the error.
Missed Items
Claims that contain errors, or are missing information, have a high likelihood of being rejected. Incorrect or incomplete information tends to include items like:
- Invalid patient personal information like name and date of birth, along with insurance information.
- Missing identifiers for health care providers like their National Provider Identifier (NPI).
- Insufficient clinical documentation that proves medical necessity of the procedures.
To counter errors and maximize success, CBS Medical Billing guarantees that claim review is exhaustive before submission, therefore reducing rejection rates.
Plan Problems
Administrative mistakes are what make insurance related denials particularly annoying. They include:
- Coverage being out of date.
- Services that do not form part of a patient’s insurance plan.
- Not meeting prior authorization requirements.
- Mistakes in Coordination of Benefits when patients have more than one insurance policy
Checking the specifics of the insurance pays absolutely necessary before any services are performed to mitigate denial risk. CBS Medical Billing offers insurance verification services that ascertain coverage prior to services being offered.
Duplicate Claims And Late Filling
Claims submitted past the cutoff date or submitted in duplicate can result in automatic denials. Some of the more prevalent problems include:
- Submitting claims that have already been processed.
- Claims past the payer’s timely filing deadline.
- Not taking action on denied claims in a timely fashion
CBS Billing System eliminates the possibility of claims being processed unnecessarily in real-time so that bills are never paid for services that are not rendered in a timely fashion.
Prevention Strategies For Cleaner Claims
In the madness of modern medical billing, consistency is your greatest ally. At CBS Medical Billing & Consulting, we’ve found that having a predictable, precise claims process dramatically reduces denials and keeps revenue flowing. Clean claims create calm—helping your team stay focused on patients, not paperwork.
Here are some field-tested practices to keep your claims clean and your revenue cycle moving:
Set Up Systems for Clean Claim Submission
Clean claims should glide through without hiccups, denials, or delays. Here’s how we make sure of it:
-
Use automated claim scrubbers to flag gaps or coding issues before submission.
-
Align documentation with payer expectations—no more, no less.
-
Train your team consistently on compliance updates and billing protocols, as well as on how to utilize the technologies that you’ve implemented for your medical practice management.
-
Apply claim scrubbing technology that analyzes for accuracy and policy alignment.
By baking quality into the front end of the billing process, you avoid friction on the back end.
Verify Insurance Info Before the Appointment
One of the most common (and preventable) reasons for denials? Incorrect or outdated insurance info.
At CBS, we offer full-service insurance verification to help our partners:
-
Confirm patient eligibility and benefits before care is provided.
-
Identify coverage restrictions and prior authorization requirements.
-
Avoid rejections due to expired plans or non-covered services.
Pre-checking insurance prevents post-submission surprises.
Implement Internal Quality Controls & Billing Audits
Even the best systems need tune-ups. Regular reviews can uncover hidden issues that delay or derail claims.
CBS supports practices by offering:
-
Internal audits to identify denial patterns and fix them fast.
-
Compliance reviews to ensure claims meet regulatory standards.
-
Ongoing training for billing staff to stay sharp and up to date with evolving codes and payer rules.
Spot the small stuff early so it doesn’t become a big problem later. Because your practice deserves to be paid—on time, and in full.
Expert Appeal Management
We’ve said it already, but we’ll say it again – even a dialed in claim process and denial management system can yield denied claims here and there. So, you’re medical practice needs an appeal management strategy in place. It’s not very nice…but some insurance companies assume Small Medical Practices don’t have the bandwidth to appeal denied claims, and sadly they’re right. That’s one place CBS Medical Billing can really help, we fight for every dollar that your medical practice deserves.
Let’s Decrease Your Claim Denial Rate Together.
Claim denial remains one the most expensive challenges for any healthcare provider. These challenges can be significantly alleviated with proper intervention. CBS Medical Billing and Consulting assists small medical practices and large healthcare facilities alike by streamlining billing, reduce claim denials, and improving revenue cycle management systems. It’s a comprehensive, wholistic approach to better medical billing. CBS helps healthcare providers maintain financial health without worry so they can prioritize patient care.That’s why we say CBS Medical Billing Is Your Medical Practice’s Missing Piece! If your practice is struggling with high claim denials, CBS Medical is ready to come to the rescue. Call us today so that we can share our tailored billing services and denial management systems with you.
