Certified Professional Coder Maggie Fortin discussed common reasons for denied claims at ASCs during a 2017 American Academy of Professional Coders meeting, according to Eye Care Leaders.
Here are six common reasons she revealed:
1. The claim doesn't identify the correct payer liable for the services. For example, worker's compensation or Medicare secondary payer.
2. There is an evaluation and management service reported along with a procedure, but there is no modifier 25 reported.
3. The claim is missing information. For example, an EPO claim might be missing value codes 48 or 49.
4. The claim was denied because of another service or procedure performed on the same date.
5. The diagnosis reported didn't meet local coverage determination or national coverage determination guidelines.
6. Duplicate billing has occurred.