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5 Common Reasons Your Claims are Bouncing Back

Billing is a complex and often tedious procedure, especially with ICD-10 codes. However, the reasons for returned and delayed claims often boil down to a few basics. Here are some of the most common billing mistakes practices make, and how to make sure your practice avoids them.

  1. Little Typos, Big Headaches

    Often reimbursements are delayed or denied because of very small, easy-to-make mistakes. “When I was assistant director of billing for a large multi-specialty practice,” says Brennan Cantrell, “the front office would often transpose the numbers or letters in policy number or omit a group number or plan ID. The front desk is extremely busy, and these are easy mistakes to make.” Cantrell, who is now commercial health insurance strategist for the American Academy of Family Physicians, says that the ideal solution is having an employee dedicated to watching for and correcting these errors. For small practices, this may not be a full-time employee, and the time saved by not having to resubmit claims might offset the time spent rooting out mistakes.

  2. Something’s Missing Here

    Sometimes payers delay payment because you didn’t send enough information. Often you can see this coming. “For example, when you file workers’ compensation claims, you will always need to submit documentation with the claim,” says Tammie Olson of Management Resource Group, an Ocean Springs, Miss., a firm offering financial management and support services for the healthcare community. “If you know you need to send the documentation to get a claim paid, do so when you file.”

  3. Please Ask First

    Another incredibly easy—but costly—mistake is not getting prior authorization. “Before you perform procedures, make sure you verify whether or not a prior authorization is required,” says Olson. “If it is, send in the request before scheduling the procedure.” And when you get ready to bill the procedure, “make sure the authorization number is on the claim,” she adds. Prior authorizations can be a pain, but having a routine for them when they are necessary can save time and prevent payment delays.

  4. Let Me See that One More Time

    Claims are increasingly denied because the patient’s coverage has been terminated or the plan or payer has changed.  Most of the time everything is just as it was the last time the patient came in but you should still ask to see the patient’s insurance card at every encounter. “People change insurance plans more often than they used to,” says Cantrell. “It’s a simple thing, but important.” Olson agrees, and adds, “If you do this, you should never have a claim denied for “policy terminated.”

  5. Keep up with the Changes

    Even when policies haven’t changed, what is and is not covered on a given plan sometimes does. You can be left holding the bag if a payer changes its policies about what procedures they cover or what labs they use, and you don’t hear about it. “Most payers send out a policy bulletin announcing these changes,” says Cantrell, “but it’s difficult to find time to keep up with this.” Large practices often have administrators who watch for these changes and pass the word on to each billing office. However, in smaller practices that job may fall to the front desk or billing staff. Make sure whoever does this understands the importance of carefully reviewing these bulletins when they are issued.


By: Avery Hurt

Ms. Hurt is a freelance writer based in Birmingham, Ala. Her work has appeared in publications including Newsweek, The New Physician, Muse, Parents, USA Today, and the Washington Post




Medicare has announced they will stop using Social Security numbers for identification beginning April 2018.  The change is required by a law enacted two years ago to discourage identity theft.

The Centers for Medicare & Medicaid Services (CMS) recently updated its web page to help health care providers prepare for the change.  Medicare plans to begin mailing the new cards with unique Medicare Beneficiary Identifiers (MBI) to each person.  According to the Medicare website, the agency is just now trying to figure out the best way to mail the cards.  They plan a “wide-scale outreach” to let beneficiaries know that they need to bring their new Medicare cards when they receive medical care.


Don’t expect CMS to reach every one of your patients and don’t count on the patients to remember to bring their new card to their appointment.  Start getting the word out to your patients now.  Let you patients know that they will be getting new cards.  Let them know that they must bring this card into your office.  Include this information on your website and in your newsletter. Prepare handouts and fliers that you can leave in your waiting room and at the front desk.  Be ready to remind your patients to bring their new Medicare cards at the time of service.

Update the patient registration information with the MBI number as soon as patients present with their new card.  It is best to scan the new Medicare card into the practice management system.  Scanning all insurance cards is a good practice since it allows the billing team to easily access the information and correct or update, as necessary.


Now is the time to make sure that the practice management software can accept the new 11 digit alpha numeric MBI.  Whether you outsource your billing and collections or have an in-house team it is imperative to make sure they are prepared to file claims with this new number.

Your billing and collections team can also participate in notifying your Medicare patients about the new cards.  Every interaction with a Medicare beneficiary is a chance to remind them about the upcoming change and what they need to do.

As part of Onpoint Medical Solutions due diligence, the practice management software has already been tested.  The software can accept the MBI, claims are accurately populated and can be submitted.  Make sure your billing and collections team has done their due diligence, as well.


CMS has indicated there will be a transition period through 2019.  A knee jerk reaction is to think it is way too early and you will worry about that later.  However, you don’t want to wait until the last minute.  If you postpone this will become a daunting task.  Contacting all of your Medicare patients will require some time.  Failure to update and utilize the MBI will ultimately result in claim rejections and delayed payments.

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