5 Common Reasons for Medical Claim Denials—and How to Prevent Them

Keywords: medical billing errors, claim denial management, RCM, insurance claims

Medical claim denials are a persistent issue for healthcare providers, impacting revenue and delaying payments. According to the American Medical Association, nearly 20% of medical claims are denied or delayed due to common billing errors. Identifying these issues early can significantly improve your revenue cycle.

Some of the most common reasons for claim denials include:

+ Incorrect or missing patient information.

+ Lack of pre-authorization or referral.

+ Coding errors or outdated CPT/ICD-10 codes.

+ Duplicate claims.

+ Services not covered under the patient’s plan.

Practices should implement robust verification processes, regularly update coding libraries, and conduct internal audits to catch these issues early. Automating front-end workflows using medical billing software can also reduce human errors.

More importantly, outsourcing to a trusted billing partner like CareRig Healthcare can drastically reduce denial rates through expert claim scrubbing, automated eligibility checks, and appeals management.

For deeper insight, explore the CMS website or consult AMA Coding Guidelines for the most up-to-date rules.