General Reasons for a Medical Billing Claim Rejection

We know that medical billing company professionals are brilliant and daily they are working on claims, In some situations some claims are rejected. Some times it may because of medical insurance company or it may some body left left out some critical information. Find list of general reasons which will be cause for Medical Billing Claims rejection.

• Upcoding
• Unbundling
• Balance Billing
• Duplicate Billing
• Lack of Medical necessity
• Insurance Patient Information
• Mismatched Treatment / Diagnosis Codes, Let's go through one by one, 

• Upcoding: It happens when a medical billing code is done as improperly changed to one which represents a more severe diagnosis or medical care. This can may be one of the reason you claim inflated.
  Ex:
  1.Coding for a name or brand medication when a generic one was used.
  2.Coding a general office visit as inpatient care.
• Unbundling: It occurs when billing charges that normally fall together under one billing code are listed separately. It makes your bill a bit higher, reason for this the items should be billed at a package rate. If you face this errors, medical billing advocate can give preferable advises.
  Ex:
  1.If multiple medical tests happens at a time, which should comes under the same code are billed separately.

• Balance Billing : It happens when you receive a medical bill for the leftover “balance” after your insurance company negotiates cost with your care provider or hospital. You need to clarify with your medical insurance company about whether or not all of the hospital charges are covered under this policy or not.

• Duplicate Billing: It happens when procedures or services are billed multiple times.

• Lack of Medical Necessity: In case, if your care provider not provide the coder with accurate information about your diagnosis, then medical code could be used in your bill. Medical billing errors like this can lead to your medical insurance company denying your claim.

• Incorrect Patient Information: In case of any misspelling of your name or a typo in your insurance ID can lead to your medical insurance company denial your claim. These errors are quite common, due to the fact that most medical bills can impact dozens of people. A mistake entering your information by any one of them can simply be passed down the line, and can cause problems when your claim is submitted to your medical insurance company.

• Mismatched Treatment / Diagnosis Codes: When a medical biller up codes your diagnosis, but leaves your medical treatment code alone, your insurance company will typically reject your medical claim due to the mismatch between the treatment and diagnosis codes. 

If these or any other medical billing errors have left you with an unfair or improper medical bill, do not despair. You can earn how to fight your medical bills, and get your medical expenses back on track.simply reach Billing Gurus for a free analysis of your medical bills.