Orthopedic Coding Alert

Reader Questions:

Avoid Automatic Resends

Question: When we know that the carrier has made a mistake in denying a claim, can I just resend the original claim again, or is it just going to be denied again?North Dakota SubscriberAnswer: While simply resending a claim that the carrier erroneously denied sounds like a logical, easy answer, in the end it may cost you more time and effort. The carrier denied the claim for a particular reason during the first round of submission. If you don't address that reason, your claim will likely just come back to you as a denial again.Possibilities: Many things can go wrong that will result in an erroneous denial. Problems with patient pre-authorization, physician credential with the carrier, an oversight on your part on the claim, or problems with the insurance carrier's processing systems could all cause an incorrect denial.Good practice: Rather than automatically resending the claim, contact your carrier representative. Discuss [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Orthopedic Coding Alert

View All