CO 13 Denial Code Description, Reasons & Resolution Guide

The financial management of healthcare practices is complex. Small mistakes can significantly affect the revenue cycle. However, major disruptions to the healthcare revenue cycle occur because of claim denials. 

Denial code 13 is among the most frequently occurring denials and stems from a simple error. It not only affects your revenue but also shows clear gaps in the billing process.

So, what can you do about it? Well, that is what this guide is all about. In this blog, we will explain what denial code 13 is, its causes, and some steps that you can take to resolve it. So, let’s start. 

CO 13 Denial Code Description

The official definition of denial code 13 is “The date of death precedes the date of service.” Let’s try to understand this in detail.

When you receive a CO 13 denial, it indicates that the insurance payer’s records show the patient was deceased before the service date mentioned on your claim. As a result, the payer automatically invalidates and rejects the claim. It highlights that the services were supposedly rendered after the patient’s recorded death date. Or that the medical services were rendered to a dead patient. 

Denial code 13 can appear on multiple documentation types:

• Explanation of Benefits (EOBs)
• Electronic Remittance Advice (ERAs) or 835 Remittance Advice 
• Clearinghouse rejection reports

Denial code 13 can be triggered as a result of a simple human error. However, frequent denials might lead the payer to suspect fraudulent billing and result in audits or worse – financial penalties, lawsuits, and contract cancellations. 

Common Causes of Denial Code 13

Understanding the root cause behind code 13 denials is essential to effectively prevent and resolve them. The following are some primary reasons for receiving a denial code 13:

Date of Death Conflicts

The primary reason for receiving a code 13 denial is that the payer’s death date records do not match your service date. This can stem from:

• Wrongful death notifications were sent to Medicare, Medicaid, or commercial payers.
• National Death Index (NDI) database mismatches.
• The healthcare facility enters incorrect patient information. 
• System synchronization delays between Social Security and Medicare databases.

Incorrect Patient Demographics

Sometimes, the date of death is correct, but insurance payers still reject a claim with code 13 due to confusion in patient identity. Confusion can arise from:

• Misspelled patient names
• Transposed digits in birth dates
• Incorrect formatting of birth dates (MM/DD/YYYY)
• Erroneous Social Security numbers
• Incorrect patient identification numbers

Administrative Errors

The most probable cause of denial code 13 is human error. Billers sometimes make mistakes in noting the correct date of death and other patient details. Some examples of such human errors can be:

• Data entry mistakes when inputting service dates.
• Transposed digits in dates (e.g., 12/03/2023 entered as 12/30/2023).
• Incorrect year entries, especially common at the beginning of a new year.
• Batch processing errors that affect multiple claims.

Improper Billing Practices

The most critical and also the most difficult denial reason to overcome is issues with your billing procedures or workflow. Some mistakes that can lead to denial code 13 are:

• Billing for services that truly were provided after a patient’s death.
• Attempting to bill for non-allowable post-mortem services.
• Continuing automated billing for Durable Medical Equipment (DME) after patient death.
• Lack of proper documentation for allowed post-mortem services.

Denial Code 13 – Prevention Guide 

Here are some strategies that you can implement in your practice to prevent code 13 denials. 

Data Collection and Management

Incorrect or missing data is the main issue behind denial code 13. So, to prevent denial, the best strategy is to improve your data collection and management system. But how can you improve this system? The following are some suggestions:

• Implement a policy for the staff to confirm and update patient demographic information at each visit.
• Establish standardized formats for entering dates, names, and identification numbers.
• Use software with built-in data validation features that can flag suspicious or impossible dates, such as future dates or transposed numbers.
• Cross-verify patient identity using multiple identifiers (name, DOB, address, insurance ID) to prevent mistakes in patient matching.

Improve Interdepartmental Communication

Poor communication between departments often contributes to denial code 13. 

• Establish clear protocols for communicating patient status changes throughout your organization.
• Create alerts in your EHR/practice management system for deceased patients.
• Develop a standardized workflow for handling deceased patient notifications.
• Schedule regular meetings with the front office, clinical, and billing teams to discuss and resolve patient information discrepancies.
• Implement a unified patient record system accessible to all relevant departments.

Staff Training and Education

Your first line of defense against denials is your staff. If your billing staff is not properly trained, denials are likely to occur. Arrange routine training sessions for all the employees related to front desk data collection and billing.

• Create job aids and quick reference guides.
• Conduct periodic audits of staff performance.

Denial Code 13 – Resolution Steps

1. The first step in resolving denial code 13 is to check and verify whether the denial reason is a death date and service date mismatch. To do this, you can check the submitted claim and your medical records/clinical notes. Also, check for any additional remark codes to understand the denial reason in detail. 
2. Confirm whether the patient was truly deceased on the entered service date.
3. Verify that the date of service on the claim is accurate by reviewing medical documentation, appointment schedules, and clinical notes.
4. Collect relevant documentation like signed visit notes, timestamped records, or other evidence showing services were provided when the patient was alive.
5. Based on the findings, decide whether to submit a corrected claim, file an appeal, or initiate a death date correction process.

How MediBillMD Can Help Resolve Denial Code 13?

The financial impact of claim denials, including denial code 13, cannot be overstated. Healthcare providers lose billions of dollars every year due to denials. The process of appealing and resubmitting claims is frustrating, and in-house billing often fails to collect the correct reimbursement amount. 

That’s where MediBillMD can help. We provide specialized denial management services that are guaranteed to reduce denials and improve revenue collection. Our billing experts have a track record of catching errors before they trigger denials, and our 97% first-pass ratio is proof of that.