Medical Billing and Coding Specialist how-to
How to Work a Denied Claim
Denials are lost revenue until someone fixes them. A systematic approach recovers money faster.
Denials are lost revenue until someone fixes them. A systematic approach recovers money faster. In short: read; categorize; check, then complete the remaining steps below.
Step by step
Read the denial reason and remark codes on the EOB or ERA.
Categorize the denial: registration error, coding error, missing authorization, medical necessity or timely filing.
Check the payer’s policy for the service.
Correct and resubmit if the claim had an error.
If the claim was correct, write an appeal with supporting documentation within the payer’s deadline.
Document every action in the account notes and track the outcome.
Safety reminders for medical billing and coding specialists
- Protect patient information under HIPAA: access only what you need for your job
- Never upcode or bill for services not documented; this can constitute fraud
- Lock your screen and secure your home workspace if remote
- Report suspected compliance problems through proper channels
Key terms
ICD-10-CM · CPT · HCPCS Level II · Modifier · CMS-1500 · UB-04: see the full medical billing and coding specialist glossary.