10 Common Reasons Top ASC Procedures Are Unexpectedly Denied
RemitDATA, an independent source of comparative analytics for reimbursement, utilization and productivity data. The database houses 25 percent of all national outpatient remits.
1. Claims or service lacks information which is needed for adjudication.
2. Duplicate claim or service.
3. Procedure or treatment is deemed experimental or investigational by the payor.
4. The benefit for this service is not included in the payment or allowance for another service or procedure that has already been adjudicated.
5. These are non-covered services because they are not deemed "medically necessary" by the payor.
6. Pre-certification, authorization or notification is absent.
7. Claims were not covered by the payor or contractor. You must send the claim to the correct payor or contractor.
8. Payment for the claim or service may have been provided in a previous payment.
9. The patient or insured health identification number and name do not match.
10. Coverage or program guidelines were not met or were exceeded.
Learn more about RemitDATA.
More Articles on Surgery Centers:
5 Ways to Boost Profits at Cash-Strapped ASCs
Outlook for De Novo ASCs in 2013 and Beyond: Q&A With Luke Lambert of ASCOA
5 Key Metrics Profitable ASCs Track
© Copyright ASC COMMUNICATIONS 2015. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
New From Becker's ASC Review
As audits approach, NueMD launches webinars on complianceRead Now
- Pain physicians - Beware of your CPA's advice on asset protection: The advice you get may be inaccurate
- President Barack Obama using Oregon Trail to drum-up young health insurance enrollees
- AAAHC accredits the Illinois University Student Health Services
- 15 statistics on ASC hours per case
- ASC by the numbers: 13 statistics