"EOB Documentation Errors and Denials" A Survey for Billers & Coders

Denials relating to healthcare PROVIDER documentation.

EOB claim denials relating to medical documentation are a specific type of error code. They are not CPT code-, modifier-, or claim form-related.

These denial codes deal with PROVIDER documentation and whether or not it meets carrier guidelines for "Medical Necessity" or other format requirements.

The error code description may state something like this:

“Needs medical records to support services” or
“An attachment/other documentation is required to adjudicate this claim/service”

As a Medical Biller & Coder, what are your primary challenges on dealing with EOB/claim DOCUMENTATION error codes and denials?

Question Title

* 1. Frequency at which you receive EOB Error Codes and Denials for PROVIDER documentation Issues? (give details in 'other' if desired)

CONSTANTLY: my facility is currently under "prepayment review" for billed services.

Frequently: many times a month or even weekly.

Infrequently:about once a month.

Rarely: a few times a year.

I have never had to deal with documentation-related EOB errors.

Other (please describe any answer that doesn't fit the above choices)

Question Title

* 2. I find troubleshooting EOB documentation errors and denials to be:

About the same effort to deal with as other error and denial codes (for example: modifier issues).

More challenging to deal with than other error and denial codes.

N/A: I have not had to deal with documentation error and detail codes before.

If more challenging, please describe your specific challenges:

Question Title

* 3. When I receive an EOB with documentation error or denial codes, I/my company or facility has a clear protocol or plan for how to resolve them. (check all that apply)

Always: I clearly understand the procedure at my office to deal with it, and quickly and successfully resolve the issue.

Sometimes: I have to do some problem solving to figure out what it takes to fix the issue, but I usually can.

Rarely: I am not quite sure what to do in the case of a documentation error/denial, and sometimes the resubmission is rejected again, or for another reason.

I have to reach out for help to deal with these types of problems, and there is usually someone in the office who can assist.

Our office/facility has to contact an external consultant to assist with handling these types of denials.

N/A: I have not had to deal with documentation errors and denials before.

Other (describe any situation that was not reflected in the answer choices above)

Question Title

* 4. When resubmitting a claim that was initially rejected for a documentation error, it is typically paid... (check ALL answers that apply)

Always or almost always: I almost never have to resubmit that same claim more than once

Sometimes it is rejected again with the same error code

Sometimes it is rejected again with a different error code

I frequently have to resubmit a single claim 3 times or more before it gets paid

There are often claims that are rejected multiple times, and end up never getting paid

Other (enter any other option that was not covered in the above answer choices)

Question Title

* 5. I know exactly where to go and who to talk to in my office to resolve the problem when there is a documentation error/denial:

Always

Sometimes

Rarely

Never

Question Title

* 6. How many employees deal with Medical Billing & Coding at your office/facility?

1 (just me!)

2-3

5 or less

5-10

More than 10

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* 7. What type of healthcare facility do you work in?

Small independent office with 3 or less providers

Larger independent office with more than 4 health care providers

Health specialty provider with more than 1 physical location

Large chain clinic/urgent care

Hospital environment

Non-hospital: What is the primary health discipline of your office/facility?

Question Title

* 8. I feel adequately prepared to handle EOB documentation-related errors and denials by my education and additional training.

Strongly agree

Agree

Somewhat agree

Somewhat disagree

Disagree

Strongly disagree

Specifically, what do you feel least comfortable dealing with?

Question Title

* 9. Regarding documentation errors/denials:
I/our office has found that the insurance carrier has INCORRECTLY denied the claim:

Frequently (more than 50% of the time)

Often (25%-50% of the time)

Sometimes (10%-25% of the time

Once in a while (less than 10% of the time)

Never (usually the carrier's denial is correct, the documentation deficiency is legitimate)

IF you have found a significant rate of denial errors on the part of the carrier, have you ever pursued a complaint against the carrier, and with whom?
(for example: a state or national professional association; the carrier's grievance and appeals department; the state insurance commission; the affected employer's benefit plan; other), and if not, why?:

Question Title

* 10. Regarding EOB documentation errors/denials: Please describe recurrent challenges and/or frustrations that you experience; collaborations with other office staff that you have found helpful in solving problems; or training or education that you believe would be beneficial in helping you reprocess these claims more successfully. (Type your answer below)

"EOB Documentation Errors and Denials" A Survey for Billers & Coders

Denials relating to healthcare PROVIDER documentation.

Question Title

* 1. Frequency at which you receive EOB Error Codes and Denials for PROVIDER documentation Issues? (give details in 'other' if desired)

Question Title

* 2. I find troubleshooting EOB documentation errors and denials to be:

Question Title

* 3. When I receive an EOB with documentation error or denial codes, I/my company or facility has a clear protocol or plan for how to resolve them. (check all that apply)

Question Title

* 4. When resubmitting a claim that was initially rejected for a documentation error, it is typically paid... (check ALL answers that apply)

Question Title

* 5. I know exactly where to go and who to talk to in my office to resolve the problem when there is a documentation error/denial:

Question Title

* 6. How many employees deal with Medical Billing & Coding at your office/facility?

Question Title

* 7. What type of healthcare facility do you work in?

Question Title

* 8. I feel adequately prepared to handle EOB documentation-related errors and denials by my education and additional training.

Question Title

* 9. Regarding documentation errors/denials: I/our office has found that the insurance carrier has INCORRECTLY denied the claim:

Question Title

* 9. Regarding documentation errors/denials:
I/our office has found that the insurance carrier has INCORRECTLY denied the claim: