3 Common Reasons a Medical Billing claim is on hold or denied

medical billing claim

Medical Billing can be a difficult road to navigate. For many first-timers, it can be confusing to pinpoint why their claims are being or hold or denied. End the confusion with these three simple explanations.

Here are three reasons why your medical billing claim may be on hold or denied:

1. Client chart (EMR) lacks a discharge plan

A Discharge Plan should be created upon admission and during the development of the client’s treatment plans. Also, do not wait until a client is discharged to develop the discharge plan. In the event that occurs, the result is a hold on your claim or a denial of your claim.

2. Medication prescription and/or confirmation of client’s compliance with medication is not documented

When a client receives a diagnosis and/or an assessment is completed demonstrating the need for medication, the insurance company or managed care provider expects to see documentation of the doctor’s orders and the client’s compliance with medication.  Without the documentation, a request for medical records and/or a denial can occur.

3. Ancillary services are provided on the same day as the Level of Care Services

The Insurance company or managed care provider will often request medical records when a client receives an ancillary service during a time in which a conflict in the daily services might occur, which can cause a delay in the claim and possibly a denial of the claim.

Stay tuned for more information and tips on medical billing. Feel free to also check out Urgent Medical Billing or call 800 -868 -8772 for billing done right.


About Karen Corcoran-Walsh

Karen Corcoran-Walsh, CAP, ICADC, MFT, ASAM is nationally known as an expert in the treatment of mental health and drug or alcohol abuse and addiction, also known as Dual Diagnosis, with a specialty in working with teenagers. Renowned as an adolescent addiction treatment center professional, she has worked in the professions of education and drug treatment for approximately 20 years. Karen is the co-founder of Inspirations For Youth And Families, LLC an adolescent treatment program and The Cove Center For Recovery, LLC an adult addiction treatment center.