13 top reasons for claims denials

Authorizations, provider eligibility and code inaccuracies were among the top reasons health system officials said claims are denied, according to a recent report from Experian Health. 

The health IT firm conducted a survey in June of 200 healthcare professionals who work in claims and are part of the decision-making process for purchases expected to improve the claims process, according to the report. The sample represented primarily executive and management roles in finance and operations. 

Those surveyed were asked to rank the top three reasons for denials, according to the report. Percentages listed indicate how often the associated reason was ranked first, when selected:

1. Authorizations — 48 percent 

2. Provider eligibility — 42 percent 

3. Code inaccuracies — 42 percent 

4. Incorrect modifiers — 37 percent 

5. Failure to meet submission deadlines — 35 percent 

6. Patient information inaccuracy — 34 percent 

T-7. Missing or inaccurate claim data — 33 percent

T-7. Not enough staff to keep up — 33 percent 

T-9. Formulary changes — 27 percent 

T-9. Changing policies — 27 percent 

11. Procedure changes — 26 percent 

12. Improperly bundled services — 22 percent 

13. Service not covered — 19 percent

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars