Denial Codes

Tired of insurance companies mistaking repeated tests as duplicates? Try using modifier 91 to overcome these denials! Little considerations, like the appropriate use of modifiers, simplify the billing process. These two-digit codes provide additional context to CPT or HCPCS codes and reduce the miscommunication between healthcare providers and payers. Modifier 91 is one such important […]

How do you report a discontinued procedure? With modifier 53! Modifiers are essential for reporting unusual and unique circumstances to payers. A common misconception about these two-digit codes? You can use them randomly to increase reimbursements. In reality, they have specific criteria and only deliver additional details about a service or procedure. Unforeseen circumstances or

Did you know the place of service (POS) also impacts your reimbursement amount? To standardize healthcare transactions, insurance companies require POS codes with electronic healthcare claims. In fact, it is a law under HIPAA. So, what happens if you use the wrong POS code? You receive a CO 5 denial code! Although this is a

Every denied claim can become a revenue loss if not addressed on time. Insurance companies use standard codes to explain why they reject your reimbursement requests. While some codes are irreversible, the good news is that you can resolve most of them with the right approach and actions. As part of our series on simplifying

Is a high claim denial rate stopping your practice from embracing the financial success it deserves? Are you worried that if you don’t take action soon, you might have to lay off staff or close your practice doors? BUT! Why go to this extreme when you can understand different denial codes, work towards their successful

Did you skip an important billing step—insurance coverage verification? If you did, you might encounter a CO 96 denial code. Claim denials are frustrating and harmful to the practice’s revenue. Denial code 96 is unique because it is not just a billing oversight but a potential patient conflict and a threat to your reputation. It

The core responsibility of healthcare providers involves clinical activities like encountering patients, diagnosing illnesses, preparing treatment plans, and rendering procedures. But, the financial aspects, such as charge entry, code selection, claim submission, payment posting, etc., are also critical for running the practice smoothly. Inaccuracies and inconsistencies in the medical billing process may lead to claim

Claim denials adversely affect a practice’s financial performance, as it means delayed or no payment against the rendered care services. Thus, healthcare facilities strive to keep the denial rate to a minimum either by implementing effective preventive strategies in-house or outsourcing denial management services to a professional revenue cycle management (RCM) company.  Today’s guide is

Why did they reject your claim this time? Denial code 15? Don’t know what it is? Or maybe you know what it means but are unsure if you can reverse it. Relax. Whatever your concerns may be regarding the CO 15 denial code, we have you covered.  In this guide, we will analyze the CO

Payers deny medical claims for many reasons. But how many of your claims are rejected due to non-covered services? You are not alone, as this is one of the most recurring problems faced by healthcare providers. Insurers use the CO 50 denial code to flag such claims. However, there is one problem! Non-covered services can