Speaker 1: An American Hospital Association survey found that 89% of respondents reported an increase in their medical billing payment denials, with 51% of those respondents reporting a significant increase. Medical billing is a difficult enough job without claim denials interrupting your administrative workflow. But you should know that it is impossible to avoid claim denials altogether. It's part of the job. Without receiving denials, how are you supposed to keep track of what's working with your billing processes and what isn't? But what you can do is create a management plan to help reduce the rate of denials altogether. And one of the most important steps in being able to do this is to familiarize yourself with some of the more common denial codes. Hi everyone, I'm Maria from eTactics, and today I'm going to talk to you about three common denial codes in medical billing. Before we get started, make sure that you subscribe to our YouTube channel by clicking the button below. Also, hit that alert bell icon so that when we post new, helpful content, you get notified. Here are a few denial codes and some tips on how to fix them. When looking at common denial codes, CO-11 is one of the more prevalent ones. This code means that a claim has a diagnosis code that does not match with the procedure or services given at the appointment. Side note here, a diagnosis code is used to define the medical concern of the patient during a doctor visit. Oftentimes, you receive this denial code because there is a mistake in the coding. Like I said before, an incorrect diagnosis code is likely the culprit, so the first thing to do is check for that. Refer to your coding team and look over the patient's record to ensure that there is not a typo or another error. If there is an error or an incorrect diagnosis, use this information to correct the claim and resubmit it. But if you cannot find an error, you have the option to appeal the claim. Remember that if you do decide to appeal the claim, always provide any records that back up the medical necessity of the procedure for the diagnosis. Next is denial code CO-15. This code means that the claim you entered has the wrong authorization number for a service or a procedure. Sometimes you may need prior approvals to receive proper coverage for certain procedures or treatments for a patient. After you gain this approval, you must then enter the correct prior authorization number in block number 23. Note that this block is on the CMS-1500 form. If you do receive this denial code, that means that there is a hiccup somewhere in this process. Number one, reviewing the claim to see whether your team submitted the prior authorization request. Number two, recheck block number 23 for any errors. And number three, if the pre-authorization information is not available, attempt to get a retro authorization for the claim. The last code we are going to go over today is CO-16, which is probably one of the most common denial codes you will come across. You will receive a CO-16 code if you submit a claim with missing information or missing or incorrect modifiers. Some other reasons for a CO-16 include demographic errors, technical errors, Invalid Clinical Laboratory Improvement Amendments or CLIA numbers, missing social security numbers. To fix CO-16 claim denials, you should pay attention to any accompanying remark codes. These remark codes are there to help you further define what information is missing so you can make changes accordingly. Again, running into claim denials is going to be inevitable. It's not a question of whether or not health insurance companies will deny claims, but instead when and why. Treating each denial as a learning experience and becoming familiar with these more common codes will help indicate workflow issues that you can not only correct, but then prevent from happening again in the future. If you'd like to learn more about denial codes, reach out to eTactics. And you already made it this far into the video, so you might as well like it, share it, and comment below.