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How To Handle A Rejected Claim From The Insurance Company

By Emily Basconford


Just when you thought medical billing couldn't get any more complicated, the new ICD-10 codes came out on October 1, 2015. The codes are a lot more complex than ICD-9. A lot of doctors are scratching their heads over it and asking themselves how they are going to get paid. A lot of doctors' offices are seeing audits by the insurance companies and a constant rejection of the claims that they are submitting to them. Doctors are often asking themselves, what gives?

Medical billing audits are becoming more common now. Medical doctors are beginning to see their practices being audited by the insurance company's. The insurance companies are tired of fraud. They often feel that doctors and blood labs are not being honest with them when it comes to their services rendered. For years' patients have been complaining about getting overcharged at the doctor's office. They went in for a simple headache and came out with a bill for $500.00. Were the tests really necessary or could the doctor just have given the patient some headache medication?

Insurance company's today are growing in power against the medical community. A good medical biller is what every medical practice needs. Without a good medical biller that understands ICD-10, your clinic may indeed fail. It seems as though doctors are losing their grip on their battle with insurance companies. Around 50% of doctors are said to be closing their private practice in order to work for a hospital that pays them a weekly salary. Some doctors see this as being a better fit because of the uncertainty of being reimbursed from the insurance company's.

The new ICD-10 codes are already showing hard times for doctors. Doctors are seeing their payments being slow from insurance companies. They are often see far less reimbursement from the claims that they are submitting. This is a problem since doctors rely on insurance companies to pay their salary. Most patients cannot afford to write their doctor a check for $200.00 or more dollars every time that they visit them. If the insurance company is not paying for the treatment, then who is?

Through the years, insurance companies have written checks to doctors because the system was set up that way. You tell the insurance company the ailment using correct codes and they submit a check back to you within a couple of weeks. Now, you must document everything to the insurance company. Your coder must know what to put down. Are you documenting the success or your patients or just submitting a claim for reimbursement? It is clear that insurance company's today wants to know more about your patients and if you are healing them. Many insurance companies are asking the question of why? Why does your patient need 2 x-rays instead of one? Why do they need 2 follow up appointments instead of the standard 1? It The system is basically forcing doctors to be more honest and open with why they are treating a patient to begin within a certain way.




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