Understanding your EOB Denial- Things to Check First!
- 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.
- 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!
- Are the TOS (type of service) and POS (place of service) codes correct? – super easy fix!
- Was the procedure bundled with another procedure?
- Were coverage guidelines followed? Check LCD and NCD.
- If denial doesn’t make sense CALL!
**Truly understanding your denial sets the tone for the next step**
Send corrected claim if….
- All items on claim are correct, this is payable! SEND APPEAL!