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Most Common Mistakes in Laboratory Billing Services that Cause Claim Denial

When a medical claim is denied it will not only affect your trust relationship with your patients but also negatively affect your revenue cycle management of laboratory billing services. Understanding the key reason behind the denial of a medical claim is the key to preventing these denials. If your practice is lacking proper resources and skilled staff, it will cause an error in the claim processing that leads to denials or rejection. So your billing staff must know how to utilize advanced billing tools that help you prevent claim denials. 

We all know that billing and coding regulations are constantly changing and to stay up to date with these changes is very complicated. No matter how efficiently medical billers and coders are working on daily claims all of us are facing denials on a regular basis. Sometimes it is due to inefficient staff or lack of proper billing tools, and sometimes front-end staff left out vital information, etc. 

Here are some common mistakes in laboratory billing services that cause a denial of the medical claims;

The insurance provider lost the claim, and then the claim expired.

The patient changed her or his insurance plan.

You send the claim to the wrong managing company.

The provider isn’t paneled with the insurance payer. 

The authorization timed out.

The patient lost his or her insurance coverage.

The provider isn’t paneled with the insurance carrie

The claim was filed after the insurer's deadline.

Outdated or improper CPT or ICD-10 codes.

Key Reasons for Claim Denial

1. Missing Proper Codes

The codes which determine what is paid are updating, modifying, and changing quarterly or yearly, and your laboratory billing service provider is responsible for operationalizing and capturing all updates. If you are using an outdated codebook or your coders enter the wrong codes, your claim definitely gets denied.

2. Miss Patient Information

Your front-end staff is responsible for collecting accurate information from the patients. Sometimes a simple omission or incorrect information like patient name, address, phone number, CNIC number, date of birth can lead to costly denials.

3. Not Verify Insurance Eligibility

One of the most common reasons for denials in laboratory billing services is not verifying the patient’s insurance eligibility. It's the duty of front-end staff to verify patients’ healthcare coverage plans and insurance eligibility. You must have diligent staff who efficiently collect and verify all patient-related data.  

4. Late Submission of Medical Claims

Timely filing starts when the healthcare service provider performs the services and insurance providers receive the claim. No matter how accurate you code or collect complete information but if you are not submitting a claim on time, it will be denied.  

5. Duplicate Billing

Sometimes due to some clerical errors, an equivalent or similar claim is often sent to the insurance providers that may result in denial of a medical claim. 

6. Failure to Meet Requirements of Pre-authorization 

Sometimes a claim is denied because prior authorization is required by the insurance payer. Approximately 60-65% of lab practitioners had difficulty in determining which procedures require preauthorization by the payers. 

Conclusion:

Claim denial is the most significant challenge that every laboratory billing services provider is facing. It will negatively impact your practice’s revenue, overall profitability, and your staff’s efficiency. Healthcare service providers must employ a well-trained and skilled staff who is well-versed with all industry changes and requirements. You must provide monthly training to them to stay current on coding and billing regulations and trends. 

If you are facing difficulties in managing your billing procedures in-house then you should outsource your laboratory billing services to a professional and certified medical billing company. By utilizing advanced billing tools, they help to reduce billing errors that cause denials. They thoroughly monitors each claim and track them until lab practitioners collect their payments.