Speaker identifies top reasons for billing claim denials

SAN ANTONIO – There are four common documentation errors that could lead to billing claim denials and audits, according to a speaker at the American Orthotic and Prosthetic Association National Assembly, here

Molly McCoy, L/CPO, teaching assistant at the University of Washington and CEO of McCoy Consulting, conducted a study of 48 Medicare claims among 21 O&P practices.

She then interviewed practitioners and identified illegibility, lack of organization, adherence to policy and clinical reasoning as common error themes. 

“Handwritten notes are a big reason claims are denied, because the reader simple cannot read them,” McCoy said. “It is a lot easier to use the denial stamp then to sit there trying to decipher one note for hours.”

Molly McCoy

She added that when documentation is not organized in a logical format, when there is no adherence to policy detail and when clinical reason is not clearly stated, claims are likely to be denied.

“When documenting, add a cover letter, respond to each denial point individually and label where to find any attachments,” she said.

She also suggested practitioners learn policy detail before working with a patient and thoroughly state how the prosthesis or orthosis features contribute to the functional ability of the patient. – by Shawn M. Carter


McCoy M. Paper B9B. Presented at: American Orthotic Prosthetic Association National Assembly; Oct. 7-10, 2015; San Antonio.

Disclosure: McCoy reports no relevant financial disclosures.

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