Coding Services

A latest survey by Harmony healthcare of more than 130 healthcare providers all over the United States revealed that the claim denial rates of a massive one-thirds of the hospitals were 10% or over and the rate of denial ranged between 6 and 13%. The accepted “danger zone” for denied claims is touted as 10%. 32% said it was caused due to coding errors while 20% said the reason was front-end concerns.

October 2021 report in Becker’s hospital reviews studied $100 billion worth of denials and $2.5 billion in audited claims to assess reason why payers denied hospital claims over coding issues. The top reasons for denials related to coding were:

1. The health insurer deems the information submitted by a provider does not support the level of service billed.

2. The procedure code is inconsistent with the modifier used or a required modifier is missing.