Here are six common reasons she revealed:
1. The claim doesn’t identify the correct payer liable for the services. For example, worker’s compensation or Medicare secondary payer.
2. There is an evaluation and management service reported along with a procedure, but there is no modifier 25 reported.
3. The claim is missing information. For example, an EPO claim might be missing value codes 48 or 49.
4. The claim was denied because of another service or procedure performed on the same date.
5. The diagnosis reported didn’t meet local coverage determination or national coverage determination guidelines.
6. Duplicate billing has occurred.
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Regent RCM: 4 internal auditing tips for ASCs
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Technology’s role in enhancing an ASC’s revenue cycle and profitability
