Denials are a significant stumbling block when it comes smooth revenue cycle management. Here are 15 statistics on the top physician practice unexpected denials, according to a Physicians Practice report.
Top unexpected denials in May 2014 by CPT code
1. 99213: outpatient physician visit, level 3
2. 99214: outpatient physician visit, level 4
3. 36415: routine blood capture
4. 97110: therapeutic procedure, one or more areas, each 15 minutes
5. 99232: subsequent hospital care, level 2
Top reason codes for denial
1. 18: duplicate claim/service
2. 16: claim/service lacks information or has billing errors
3. 97: benefit for service is included in the payment for another service/procedure that has already been adjudicated
4. 96: non-covered charges
5. 29: time limit for filing has expired
Top specialties with the most unexpected denials
1. Physician therapy: 12 percent
2. Pediatrics: 12 percent
3. Family medicine: 11 percent
4. Internal medicine: 10 percent
5. Radiology: 9 percent
CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
More Articles on Coding and Billing:
Narrow networks: ASC industry boon or bane?
5 articles on ASC out-of-network strategy
Partnership pitfall: what happens to ASC software after joint venturing?
Top unexpected denials in May 2014 by CPT code
1. 99213: outpatient physician visit, level 3
2. 99214: outpatient physician visit, level 4
3. 36415: routine blood capture
4. 97110: therapeutic procedure, one or more areas, each 15 minutes
5. 99232: subsequent hospital care, level 2
Top reason codes for denial
1. 18: duplicate claim/service
2. 16: claim/service lacks information or has billing errors
3. 97: benefit for service is included in the payment for another service/procedure that has already been adjudicated
4. 96: non-covered charges
5. 29: time limit for filing has expired
Top specialties with the most unexpected denials
1. Physician therapy: 12 percent
2. Pediatrics: 12 percent
3. Family medicine: 11 percent
4. Internal medicine: 10 percent
5. Radiology: 9 percent
CPT Copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
More Articles on Coding and Billing:
Narrow networks: ASC industry boon or bane?
5 articles on ASC out-of-network strategy
Partnership pitfall: what happens to ASC software after joint venturing?