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The Value of Collectively Understanding Remark/Reason Codes

What this chart illustrates: Denied claims are a daily norm. We fix them within our practice management/billing systems, make notes and then move on to the next round of denials/correspondence. Most practice management systems today are not designed to review collective data from a historical viewpoint. Therefore, we typically treat each denial as a single error instance and do not “learn” how to alter our revenue cycles to prevent mistakes from occurring again in the future. Below is an example of all reason/remark codes received from Medicare of Arkansas as related to CPT code 99213 – Established Patient Office Visit.

What this means to you: Having access to the denial reason/remark codes for a given CPT code by payer will allow you to understand globally what errors are causing most of your denied claims. In the example below, there were 114 occasions when Medicare was billed when another insurance company was the responsible party (reason code 22). Knowing this, you would be able to alter your eligibility checks and front office insurance verification processes to ensure that the correct insurance/responsible party is identified prior to sending the claim out, ultimately reducing your practice’s days in accounts receivable. Additionally, in this example, it is clear that there are issues with diagnosis assignment, additional information requested and even billing services after the date of death.  A complete understanding of your denials will guide you to the problem areas in your revenue cycle.

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