For the study, the revenue integrity software provider and consultant analyzed $100 billion worth of denials and $2.5 billion in audited claims.
Here are the top reasons for denials related to coding issues, according to Hayes:
1. The health insurer deems the information submitted by a provider does not support the level of service billed.
2. The procedure code is inconsistent with the modifier used or a required modifier is missing.
3. The diagnosis is invalid for the date or dates of service documented.
4. The diagnosis is inconsistent with the procedure.
5. The diagnosis was not covered.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.