Frequently Asked Questions About Our Billing Solutions
Browse through our comprehensive FAQs for clear, reliable answers that address common queries and simplify your understanding of our billing services.
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How do front desk errors directly impact claim denials?
Even small demographic errors trigger automatic payer rejections. For example, entering the wrong subscriber relationship or a single incorrect policy digit rejects the claim. Training staff to verify eligibility at every visit prevents avoidable front-end denials.
Why do claims deny even after eligibility verification?
Eligibility confirms coverage but not benefit limits. For example, physical therapy may show “covered” but with a 20-visit cap. Billing beyond limits without prior authorization results in CO-197 denial. Checking frequency and benefit caps is essential.
How does missing or late prior authorization affect payments?
High-cost services like MRIs or injections deny when authorization isn’t secured. For example, billing CPT 72148 without payer approval leads to complete nonpayment. Even if performed, retro auths are rarely accepted. Proactive tracking avoids major revenue loss.
What causes frequent claim rejections in electronic submissions?
Most rejections occur due to invalid CPT/ICD linkages or missing data elements. Example: billing CPT 93015 (stress test) with R07.9 (chest pain unspecified) rejects for medical necessity. Proper code specificity and clearinghouse edits prevent these.
Why do payers downcode Evaluation & Management (E/M) visits?
Insurers downcode when documentation doesn’t justify complexity or time. Example: billing 99215 requires either 40–54 minutes or high MDM. If notes only show “patient follow-up,” payers reduce payment to 99213. Complete documentation avoids downcoding.
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