Claim denials disrupt your practice’s revenue cycle, which you may not immediately notice. Beyond the lost money, each denied claim silently burdens your practice. It diverts valuable staff time from patient care and engagement to endless reworks and follow-ups. Also, it creates a growing pile of paperwork that slows everything down.
This constant struggle to get paid for the rendered services drains energy, resources, and focus. Ultimately, you struggle to scale your practice and give patients the best care.
This guide is one from our denial codes library. It will help you master denial code PR 272, common reasons that trigger it, prevention strategies, and essential steps to resolve it.
So, without further ado, let’s get started!
Denial Code PR 272 – Description
If you have received a denial code PR 272 on your medical claim, it means that your claim failed to fulfill the coverage guidelines set forth by the payer.
Simply put, the patient’s insurance plan does not cover the procedures or services rendered due to specific limitations or other requirements.
Common Causes of Denial Code PR 272
The following are some of the reasons behind receiving a denial code 272:
Failure to Meet Coverage Guidelines
The main reason behind denial code 272 is the failure to meet the insurance coverage guidelines. In many cases, it means there were certain limitations to the insurance plan. However, it can also occur if you skip some specific requirements set by the payer while submitting the medical claim.
Inaccuracies in Patient Information
When the patient checks in at your clinic’s front desk, the staff collects the necessary details. All this information needs to be accurate and up to date. For instance, discrepancies in the patient’s insurance plan details may leave the billing staff with the perception that the rendered services are covered. But in reality, the services are not covered. As a result, denial code 272 is triggered.
Failure to Obtain Prior Authorization
Many procedures require pre-authorization from the payer. For the unversed, it is a special request that you seek from the payer to perform the service that may be outside of their set guidelines. When your billing department skips this step, it often triggers the denial code PR 272.
Errors in Coding
Sometimes, inaccurate diagnosis and procedural codes also indirectly lead to denial code 272. How? The procedure might have been covered by the patient’s plan, but the billing staff used the CPT code for a service the insurance plan does not cover. As a result, the payer denies the payment for your medical claim, assuming the rendered services are out of scope.
Inadequate Documentation
Charting is a key component of any encounter. That is, physicians are required to document everything that happens during a patient visit. The billing department reviews the chart to create the medical claim. If anything is amiss or was left undocumented by the biller during translation, it can trigger the denial code PR 272.
Delays in Claim Submission
Late claim filing is another culprit leading to denial code 272. It often occurs when the patient’s insurance plan has expired, changed, or no longer provides coverage for the rendered procedure.
Denial Code PR 272 – Prevention Guide
Discussed below are the mitigation strategies for denial 272.
Verify Insurance Eligibility
One way to avoid denial code 272 is to verify insurance eligibility before rendering services. You can do this by calling the payer or by using an online eligibility verification tool.
Obtain Pre-Authorization
Acquiring prior authorization should be part of your billing workflow to avoid potential payment delays due to the denial code PR 272. It is an integral step as it lets you determine beforehand whether or not the patient’s insurance plan covers a specific service.
Ensure Accurate Documentation
Detailed and accurate documentation is another essential medical billing requirement. It helps you demonstrate the medical necessity of the rendered services, ensures timely reimbursements, and, above all, saves you from most of the denials, including PR 272.
Stay Current on Payer Policies
Billing guidelines not only vary across payers, but the insurance plans frequently change as well. One service that you performed and received reimbursement for a month ago for a patient enrolled in the same insurance plan may get removed, or the terms for its payment may change.
Thus, it should be a regular practice to review the relevant payer policies and billing requirements to avoid denials related to PR 272.
Invest in Staff Training
Educate your staff on the billing best practices and ways to reduce the likelihood of denial code 272. These may include training them on the varying payer requirements and state and federal laws.
Besides, you can conduct training sessions for the entire billing team when a federal program, such as Medicare/Medicaid, announces major changes. It will ensure all team members are on the same page.
Conduct Internal Audits
Training only takes you so far! Implement robust methodologies and key performance indicators (KPIs) to ensure your team consistently utilizes billing best practices. You can bring balance to your organization by conducting regular internal audits. Check for trends that trigger denials related to PR 272. Address the issues to mitigate the risk of future denials.
Denial Code PR 272 – Resolution Techniques
The denial code 272 mitigation strategies we discussed in the previous section will significantly reduce its likelihood. However, if you still receive it, the following are the steps to work towards its successful resolution:
- Your first step should be to review your submitted medical claim and look for mistakes such as incorrect patient information and coding errors.
- In case of an error in the claim, rework, resubmit, and attach the supporting documentation.
- Proactively follow up with the payer to ensure timely resolution.
- But what should you do if there are no errors in the claim? Check the patient’s insurance plan again to determine if the billed service is covered. If it is, then file an appeal to revoke the denial.
- If the denial is valid, your next step should be to discuss the payment options with the patient. Offer the patient payment plans or financial assistance. It will help you avoid unnecessary write-offs.
How MediBillMD Can Help Resolve Denial Code PR 272?
At MediBillMD, we hire only certified professional coders (CPCs) and billing specialists with relevant industry experience. These highly trained professionals meticulously create claims, paying close attention to every detail.
As a result, you get clean claim submissions and comprehensive documentation. A clean claim means zero coding errors, inaccuracies in patient details, and missing documentation. It significantly reduces the likelihood of denials, including denial code PR 272, and improves the collection rate, ultimately leading to a healthier revenue cycle. While we are experts at preventing denials, we can also manage your denial code 272 for you. So, browse our denial management services and notice the difference.
