ALL THINGS MEDICAL OFFICE

MISTAKE #1

DENIALS FOR LACK OF VERIFICATION

• Members coverage terminated
• Date of service prior to coverage
• Services not authorized
• Services not covered by plan benefits
• Maximum benefits met

VERIFY

MiSTAKE #2

DENIALS DUE TO INACCURATE PATIENT INFO

• Payer cannot identify the patient
• Invalid subscriber or group number
• Patient name and date of birth mismatch
• Denials due to coordination of benefits
• Denials due to incorrect patient relationship

ACCURACY

MISTAKE #3

DENIALS DUE TO INCOMPATIBLE CODING

• Denials due to no medical necessity
• Procedure does not match authorization on file
• Diagnosis and procedure mismatch
• Services not covered by plan benefits
• Diagnosis or procedure incompatible with patient's sex

COMPATIBILITY

MISTAKE #4

AVOID FRAUDULENT BILLING ACTIVITY

• Do not bill for the same procedure more than once
• Do not bill for the wrong procedure, test, or treatment
• Do not bill for services never performed
• Do not upcode or unbundle charges for higher payment
• Do not bill for medical equipment never provided

HONESTY