2024 Gastroenterology Reimbursement and Coding Update | November 2023-Top Denials in GI and How to Avoid Them

Video Transcription

Video Summary

In this video, the speaker discusses the reasons why medical claims get denied and the cost it incurs for medical practices. They explain that although electronic records and claim scrubbers were supposed to make claim submission and payment quicker and easier, claims still get denied at the payer level, resulting in delayed payment and financial losses. The speaker emphasizes the importance of preventing claim denials by submitting claims correctly the first time to avoid the costly process of trying to get a denied claim paid. They also explain the concept of an Explanation of Benefits (EOB) and how it provides information about the processing of a claim. The speaker then delves into specific denial reasons for gastrointestinal claims, such as bundling issues and incorrect coding, providing examples and tips for accurate billing. They also touch on modifier 25 and the importance of documenting medical necessity and specific diagnoses. Finally, they advise providers to research the reasons for denial and not accept the initial review, but to appeal and involve patients in the process.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Meta Tag

Concept Medical Claim Denial

Concept Explanation of Benefits

Concept Healthcare Coding

Concept Modifier 25

Concept Medical Necessity

Keywords

medical claims denial

cost of denied claims

preventing claim denials

Explanation of Benefits (EOB)

gastrointestinal claims denial

denial appeal

Medical Claim Denial

Explanation of Benefits

Healthcare Coding

Modifier 25

Medical Necessity