One of the primary challenges that medical billing professionals face is dealing with denial codes. Denial codes in medical billing are essentially explanations given by insurance companies as to why a claim was denied. These codes can be very frustrating, as they often require additional work to resolve the issue.
As reported by American Academy of Family Physicians (AAFP), the industry average for denial rates is between 5 and 10. However, there are many variables associated with this and therefore denials can frequently go up to 18%.
Denial rates vary for individual providers largely due to the lack of standardization within the healthcare system for denial codes in medical billing.
What are the most common denial codes in medical billing?
Would you like to understand the insurance speak a little better, by going through some of the most common denial codes?
If yes, then you are at the right place. In this article, we will discuss common Denial Codes in medical billing and provide tips on how to avoid denials.
Common Denial Codes in Medical Billing
CO-16 – Claim/Service Lacks Information or has Submission/Billing Error(s)
This denial code is often issued when there is missing or incorrect information on the claim. It can also occur when there are errors in the billing or submission process. This could include missing or incorrect patient information, incorrect procedure codes, or incorrect billing codes.
Solution: The best way to resolve this denial code is to review the claim thoroughly and ensure that all required information is present and correct. The medical billing professional should review the patient’s chart and compare it with the claim to ensure that all medical codes in medical billing match. It is also important to ensure that the correct insurance information is present.
CO-18 – Duplicate Claim or Service
This denial code occurs when a claim is submitted more than once for the same service. This can happen if the provider submits the claim to more than one insurance company, or if there is an error in the billing process.
Solution: To resolve this denial codes in medical billing professional should review the patient’s billing history to determine if the claim was submitted more than once. If it was, the duplicate claim should be identified and removed. It is also important to ensure that the claim is submitted to the correct insurance company.
CO-22 – This Care May Be Covered by Another Payer Per Coordination of Benefits
This denial code is issued when the insurance company believes that another insurance provider should cover the claim. This could happen if the patient has multiple insurance providers, and the provider did not submit the claim to the correct insurance company.
Solution: To resolve this denial codes in medical billing professional should review the patient’s insurance information and determine if there is another insurance provider that should be billed. If so, the claim should be submitted to the correct insurance provider.
CO-29 – The Time Limit for Filing has Expired
This denial code is issued when a claim is submitted after the time limit for filing has expired. This could happen if the provider did not submit the claim within the required time frame or if the insurance company did not receive the claim in a timely manner.
Solution: To resolve this denial codes in medical billing professional should review the time limit for filing with the insurance company and determine if the claim was submitted within the required time frame. If the claim was not submitted within the required time frame, the provider should submit a request for an extension. If the insurance company did not receive the claim in a timely manner, the medical billing professional should ensure that the claim is resubmitted promptly.
CO-45 – Charges Exceed Your Contracted/Approved Amount with the Patient
Co 45 denial code is issued when the provider charges more than the contracted or approved amount for a service. This could happen if the provider did not check the patient’s benefits before providing the service or if the provider charged more than the approved amount.
Solution: To resolve this denial codes in medical billing professional should review the patient’s benefits and determine if the provider charged more than the approved amount. If the provider did charge more than the approved amount, the medical billing professional should review the contract with the insurance company to determine if the charges are reasonable.
Claim denials are a common problem in medical billing that can cause significant delays and costs for healthcare providers. Understanding denial codes and implementing best practices can help providers avoid denials and ensure timely payment for services rendered. By verifying patient information, checking eligibility, using correct codes, submitting claims timely, and monitoring claim status, healthcare providers can improve their billing practices and reduce the risk of claim denials.
Need help addressing denied medical claims? EMPClaims can help with an expert team of medical billing professionals to help you navigate the most common denial codes, and find solutions to ensure your claims are paid.