Physician billing & denied billing. What do you do?

In this post, what I’m hoping to touch on is a very common issue that every billing company, staff member or coder comes across daily. It’s the issue of “denied billing.” In other words, you send a claims form in the way that we talked about in another post, and the insurance company doesn’t accept to make the payment. This can create a very timely situation that can last from a few minutes, to even a few hours (or worst case scenario you don’t get paid.)

It’s really a troubling thing to deal with, as in the healthcare industry the whole team should be focused on serving patients – not jumping through loopholes. So I will be outlining below a few common reasons you are getting denied some billings and a few things you can do about this problem. Note that a very average denied claim statistic is about 20% of the claims sent. In some cases and in cases where – as I will detail below – the person in charge of the billing is doing a lousy job,  the denied billings can reach a percentage of 80%.

So probably the main reason you are having denials may start and end with the front desk. If the people in charge aren’t doing the registrations correctly, then coding or managing the rest of the billing process, wont really matter. Your staff or people in charge can be experts in coding. But if they are making registration mistakes, then that has no value. According to some sources and statistics, many times over 50% of claims are being denied, because of front desk mistakes. 

If your staff members at the front desk are looking something like the picture below (or even eating, chatting, laughing while working) then a ton of mistakes are in the makings.


Focusing on any given task or job is essential for success. But even more importantly, being focused on billing correctly & filling in the information correctly is essential. Before the patient even sees the physician or healthcare professional, all the information to be used in the claims form needs to be accurate and complete. That means that small details can’t be missing from the picture. That may cause a denied claim.

Examples of wrong information being filled in could even start with writing down the wrong insurance being used. Most of the times it’s the front desk’s fault. Many times the cards being submitted by the patients, are complex and you don’t really understand what type of insurance is he/her using (whether it’s Medicare or whatever.) So having the people in charge see clearly through the information being provided to them by the patients, is extremely important for them  to transfer that information exactly the way it’s supposed to be transferred, on the claims form.

A second example of simple mistakes that could ruin the smooth billing process is misstated ID information. A wrong digit can trigger a denial. And the billing professional needs to sit down and maybe call the patient, or send postcard to get some information missing. In short: a very small mistake can really turn out to be a huge problem.

A very common question being asked many times by people is: What is the time frame between the denial and the opportunity to fix any mistakes?

The best answer to that would be “depends.” Depends on the type of insurance. I know for a fact that United Healthcare (PPO) gives you about 90 days to fix errors. Other types of insurance such as Medicare can maybe give you up to a year. Which means that if the information stated isn’t edited correctly within that time frame, you could very well not get paid.

So you see how a seemingly small problem can turn out to be a very long and complex situation. Our advice would be that you “do something”with the people at the front desk to eliminate these kind of mistakes or do something to fix/decrease the denial statistics.

If you even need to replace a few people (or educate them) don’t hesitate to do that either. The whole practice or healthcare facility is running based on these billings. Not getting paid or having to spend money to get paid for stupid mistakes, is not going to be your best practice. Make sure the people you are hiring know exactly what they are doing, or at least are decent enough and can learn and do things correctly.

Reach out to us with any questions and stay tuned for upcoming posts.

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