Dealing with medical billing denials can be a major challenge for healthcare providers. Not only do these denials delay payments, but they also create a significant administrative burden. However, knowing the top 10 denial codes in medical billing can help you prevent these issues and streamline your revenue cycle.
At Vinali Group, we specialize in providing solutions that reduce these denials, ensuring that your practice runs smoothly and your payments are received in a timely manner. Let us know what you need, whether you're ready to improve your billing process or just want more information, we're here to help. Fill out the form or reach out to us today!
What is the Impact of Medical Billing Denials?
Medical billing denials are not just a nuisance; they can seriously impact your practice's finances. Denied claims result in immediate revenue loss and require significant time and resources to resubmit and correct. According to studies, healthcare providers can lose anywhere between $50-$100 per claim due to insurance eligibility issues and between $75-$150 per claim for coding and documentation errors.
What is The Cost of Denial Resubmissions:
| Denial Type | Financial Impact | Resubmission Cost |
|---|---|---|
| Insurance Eligibility Issues | Direct revenue loss | $50–$100 per claim |
| Coding and Documentation Errors | Revenue delay or loss | $75–$150 per claim |
| Claim Filing and Submission Issues | Delayed or lost revenue | $25–$75 per claim |
Top 10 Denial Codes in Medical Billing: What You Need to Know
Below are the top 10 denial codes in medical billing that your practice should be aware of to prevent costly delays and ensure timely reimbursements.
1. CO-4: Missing Modifier
A missing modifier is one of the most common reasons for claim denial. Modifiers are critical for providing additional details about a procedure, such as location, complexity, or multiple procedures. Missing or incorrect modifiers often lead to CO-4 denials.
Solution: Review the procedure codes to ensure that all necessary modifiers are included. Regular audits of your coding practices can help you identify and prevent these errors.
2. CO-11: Diagnostic Coding Error
The CO-11 denial code means that the diagnostic code provided does not match the patient’s condition or the services rendered. This is a common issue that occurs when the diagnosis doesn’t justify the treatment provided.
Solution: Ensure that your clinical documentation is thorough and accurate. Train your staff on proper coding practices to link diagnosis codes to the right services.
3. CO-15: Authorization Number Problem
CO-15 codes are issued when a service requires prior authorization, and either the authorization number is missing, invalid, or the authorization was not obtained before the service was provided.
Solution: Keep track of prior authorization requirements and verify that all necessary approvals are obtained before services are rendered. If authorization was obtained but the number is missing, promptly follow up with the payer to get the correct details.
4. CO-16: Lack of or Incorrect Information
CO-16 is a broad denial code that often indicates missing or incorrect data on the claim, such as incorrect patient information or missing modifiers.
Solution: Ensure that all required information is accurately completed on every claim. Establish a checklist to verify that each field is filled out correctly, and utilize software to help reduce human errors.
5. CO-18: Duplicate Bill
This code is issued when the same claim is submitted more than once. Often, this happens due to system errors or manual mistakes, resulting in duplicate claim submissions.
Solution: Use electronic remittance advice to check for duplicates before submitting claims. Double-check your practice management systems to ensure claims are not submitted multiple times.
6. CO-22: Coordination of Benefits Mistake
The CO-22 denial code occurs when a claim is submitted to the wrong payer or when the primary, secondary, or tertiary payer is not properly identified.
Solution: Always verify the patient’s insurance coverage and make sure the claim is submitted to the correct payer. Regular eligibility checks can prevent these types of denials.
7. CO-29: Expired Time Limit
This code indicates that the claim was submitted after the payer’s filing deadline. Missing this deadline can result in non-payment of the claim.
Solution: Set up automated reminders or a system that tracks claim deadlines. Ensure that claims are submitted within the allowable time frame to avoid the CO-29 code.
8. CO-50: Service Not Medically Necessary
The CO-50 code is issued when the payer determines that the service provided was not medically necessary based on the information submitted.
Solution: Provide detailed clinical documentation to justify the medical necessity of the service. If necessary, submit additional information to support the need for the procedure.
9. CO-97: Already Adjudicated
The CO-97 code is issued when a claim has already been processed, whether under a bundled payment system or a prior claim.
Solution: Verify that the service has not already been covered or adjudicated. Regularly review your claims before submission to ensure there is no overlap or duplication.
10. CO-167: Diagnosis Not Covered
A CO-167 denial code indicates that the diagnosis provided is not covered by the patient’s insurance plan. This usually happens when the diagnosis code submitted does not align with the payer’s policies.
Solution: Double-check that the diagnosis submitted matches the payer’s coverage guidelines. Ensure your coding is accurate and in line with the payer’s requirements for that specific diagnosis.
How Can Vinali Group Help Reduce Medical Billing Denials in Your Practice?
At Vinali Group, we understand the complexities of medical billing and the significant impact that denials can have on your practice’s financial health. Our virtual medical billing solutions are designed to help you reduce denials, increase claim accuracy, and streamline your revenue cycle management.
Here’s how we can help:
1. Expertise in Medical Billing and Coding
Our team of certified billing specialists ensures that every claim is processed correctly, reducing the risk of coding errors and omissions. We stay up to date with the latest coding standards and payer requirements, so you don’t have to.
2. Proactive Insurance Verification
We implement advanced tools to verify patient insurance eligibility before services are provided, preventing denials due to coverage issues such as Code 204 (patient not covered) and Code 27 (coverage terminated).
3. Real-Time Claim Status Tracking
With real-time tracking of your claims, we ensure that any issues are flagged early, allowing for prompt resolutions. This helps you avoid delays and resubmissions.
4. Automated Compliance Updates
We monitor regulatory changes and updates, ensuring that your practice stays compliant with the latest rules and avoiding denials due to outdated or incorrect information.
5. Comprehensive Billing Solutions
From claim submission to follow-up, we handle the entire billing process. This reduces administrative burdens, improves cash flow, and minimizes the impact of denied claims.
Contact Vinali Group Today!
Partnering with Vinali Group gives you the expertise and support you need to improve your revenue cycle management. We reduce the likelihood of denials, streamline the billing process, and help you focus on what matters most, providing excellent care to your patients. Contact us today to learn how our tailored solutions can help optimize your medical billing and prevent costly denials.
