Understanding your EOB Denial- Things to Check First!

Woman answering the phone wearing scrubs

  1. Does the documentation justify the CPT and ICD10 billed? – Double check notes on visit to make sure there was enough documentation provided to use the provided CPT and diagnosis codes.  
  2. Were the modifiers appropriate or missing- denials can be an easy fix if an incorrect modifier was used or was missing.  Make sure correct modifiers are used for certain insurance plans!
  3. Are the TOS (type of service) and POS (place of service) codes correct? – super easy fix!
  4. Was the procedure bundled with another procedure?
  5. Were coverage guidelines followed? Check LCD and NCD.
  6. If denial doesn’t make sense CALL!


**Truly understanding your denial sets the tone for the next step**

Send corrected claim if….

  1. All items on claim are correct, this is payable!  SEND APPEAL!


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