According to AAFP, the industry standard is to keep your claim denial rate below 5%. But achieving this can be quite the challenge. Navigating the medical billing and coding world unscathed by roadblocks isn’t possible, unfortunately. But reducing the rate of claim denials is.
Today, we are taking another deep dive into the world of denial codes to tackle denial PR 27. If you’ve ever been stumped by this code, you’re not alone. But by the end of this video, you’ll be equipped with the knowledge and strategies to conquer.
Before we jump into the specifics of PR 27, let’s go over what a denial code is. These codes are key when it comes to indicating why payers deny healthcare service reimbursement.
Knowing these codes, or at least the most common ones, can help you avoid unnecessary revenue loss. This enables your team to collect claims faster and with less employee labor.
So, what exactly does PR 27 mean? Insurance companies send these denial codes to healthcare providers who incur expenses for a service or treatment after a patient’s coverage is over. The PR stands for “Patient Responsibility”. When you see this abbreviation preceding a denial code, you know that it is the patients who are in charge of paying the expenses. Expenses may include things such as copays or deductibles.
Here are four of the most common reasons for receiving denial code PR 27.
First up, failing to update a patient’s insurance information before providing services. Imagine billing to their old insurance plan after coverage has already ended! It’s not a good look on your billing team and is a surefire way to trigger PR 27.
Another cause for denial code 27 comes from delays in submitting claims. Healthcare providers and their billing teams may not always have their claims entered in a timely fashion. If this is the case, and you end up submitting a claim to the payer after the patient’s coverage termination date, you will likely receive this denial code. Remember, in the world of medical billing, timing is everything.
Make sure to keep open communication with your patients. Let’s circle back to what happens when you don’t update a patient’s insurance information. I already emphasized the importance of keeping up to date with patients’ payer coverage. But if a patient doesn’t disclose that their coverage has been terminated, how are you supposed to know to not bill it? How can you possibly have the right insurance information if discourse between your billing team and your patients doesn’t exist?
Make sure to regularly ask if patients still have the same insurance. If they don’t, be sure to grab the new insurance information before they receive their next services.
Finally, keep a lookout for common billing errors. These might include incorrect dates or general coding errors. An unrelated billing error could cause a claim to be returned multiple times, which could be detrimental. These errors might take too long to fix. By the time you do successfully send the claim, you run the risk of submitting it after insurance coverage ends. Resulting in denial code PR 27.
Navigating the intricacies of the medical billing process, like understanding claim denials, takes time and patience. However, it is essential for maintaining good financial health and keeping your revenue cycle management running smoothly.
All providers must consider these common causes into consideration when it comes to minimizing their claim denials. This will only help healthcare organizations implement better revenue cycle management practices and help to better streamline administrative duties. Ensuring timely reimbursement for services rendered, as well as sustainable financial health, starts with minimizing your claim denial rate.
Through different practices, such as employee education and keeping open communication with your patients, you can reduce the occurrence rate of claim denials. Streamline your administrative tasks, enhance your profitability, and reinforce the overall stability and efficiency of your organization with these proactive measures.
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