Neurology & Pain Management Coding Alert

If you-ve compiled a list of your top-10 denials, compare them with this list from Medicare. Payoff: You can determine where you stand compared to other practices- most frequent denial reasons.

Remember: Not every insurance denial automatically means your practice made an error. If you scrutinize your EOBs carefully, you might find that you are wrong some of the time and that the insurer is wrong sometimes. In some instances, you might simply need to notify the payer why they were wrong to reject your claim.

Each Medicare carrier lists its own top-10 reasons for denying claims. The following denials represent the top-10 reasons, compiled by averaging data from nine different Medicare carriers:

• Duplicate claim submissions
• Bundled services
• Individual provider number and/or group number missing from 24k or 33 of the CMS-1500 form
• The payer does not deem the diagnosis linked to the procedure a -medical necessity- for that service
• Medicare is the secondary payer but is being billed as primary
• Non-covered services
• Patient is not a Medicare beneficiary
• UPIN and name of ordering or referring physician are missing or invalid
• Incorrect modifier usage
• Procedure is a -screening- service and therefore not eligible for payment.