Internal Medicine Coding Alert
What Makes a Clean Claim?
Question: We are having problems in our internal medicine practice with the number of claims we have had to appeal lately. More often than not, the reason for the denial is our office's insufficient initial reporting. What are the most important things to remember for filing clean claims?
Make sure the policy number and ID number are accurate.
Obtain insurance eligibility verification.
Verify other patient information (proper name, birth date, address, etc.).
Confirm the info the provider gave you for posting charged entries.
Check that CPT and ICD-9 codes are up-to-date and as specific as possible.
Make sure, if applicable, that you have the referral authorization number on the form and, if required, a referring doctor's UPIN or HPI.
California Subscriber
Answer: Send clean claims the first time by using this checklist to guide your office. Check it before sending every claim to ensure accuracy:
- Reader Question and You be the Expert were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management in Spring Lake, N.J.
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