How to Handle Reimbursement Issues

by | Aug 21, 2019 | Medical Billing

Medical coding and billing is by its nature a very precise business, because accurate codes must be used to indicate specific medical procedures provided by a caregiver. If any mistakes are discovered in the coding and billing process, the claim will be denied by an insurance company, and the caregiver will be obliged to resubmit the claim. This of course, can be very time-consuming, and it can result in reduced revenue for a medical facility, especially when several claims are denied at the same time.

The best way to reduce errors made in coding and billing is to train the staff very well so that such mistakes are minimized. However, at least a few errors in coding and billing will always crop up, and when they do, these need to be handled promptly and efficiently, so that minimum delay is encountered for reimbursement. Here are some ways that medical coding and billing errors can be handled in the most efficient manner.

Inadequate training

Even if there are minor issues involved in a claim to an insurance company, it will probably be rejected, and must then be resubmitted. All information included on any claim must have current and relevant information on it, and must be presented with the proper billing codes. The best solution for this situation is to conduct regular training sessions for your medical billing staff, so they are aware of proper standards such as ICD and HIPAA. This will undoubtedly increase the number of approved claims for reimbursement.

Poor documentation

Another frequent cause for rejection by insurance companies is that inadequate documentation is provided with the claim, so that it’s unclear about which processes were used in providing service. This happens most frequently on medical claims for patients who are insured by Medicare. Some of the important information required on these claims is often submitted in a confused state, or is not included at all.

There are also some diagnostic procedures which are hard to represent on a medical claim, and a good amount of confusion can arise from these. To avoid situations like these, guidelines for allowable medical billing services should be consulted, especially those issued by the Centers for Medicare and Medicaid Services. When necessary, information provided on claims should be verified by a second party, when it seems likely that there might be confusion surrounding a particular claim.

Data redundancy

It often happens that a duplication of data is included on medical claims, and this will often result in having a claim denied or receiving only partial reimbursement. This kind of issue most often appears when claims are handled manually, rather than through some kind of electronic process. Whenever there is any kind of confusion or unclear billing claims, an insurer is very likely to simply reject the claim, and require the caregiver to resubmit something which is more clear.

Data redundancy occurs most often on those claims associated with Medicare and Medicaid, and these are carefully scrutinized by insurance companies. One of the newest trends in the medical billing industry is to use software included in Electronic Healthcare Records, which at least partially removes the human element from medical claims. This can cut down on the number of human errors involved, and can virtually eliminate data redundancy on claims. It’s always worth having a second person check a medical claim whenever there’s any thing on the claim which is not crystal clear.


Healthcare in this country is becoming more competitive with the passage of every year, and that means maintaining regular income of revenue is critical. One of the best ways of ensuring that your medical facility has a steady stream of income is to minimize any mistakes made on claims sent to insurance companies. By following some of the recommendations referenced above, you should be able to cut down on any errors made, and improve your revenue flow significantly.

Professional handling of reimbursement issues 

All medical facilities encounter at least some issues with reimbursement. However, an experienced and efficient organization such as Medical Healthcare Solutions of Andover, MA can keep these issues to a minimum, and has the expertise to get them resolved promptly when they do occur. For worry-free medical coding and billing, contact Medical Healthcare Solutions, and receive prompt compensation for your provided services.

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