The reasons for denial can include billing errors, missing information, inadequate patient coverage, and more. Your practice will typically receive an Explanation of Benefits (EOBs) with the reason for the denial.

Other common mistakes include entering incomplete or incorrect information for a patient or provider or accidentally billing for the same service more than once (known as duplicate billing). Information from the doctor’s notes may also get lost or misinterpreted by a billing department.

Factors Affecting Reimbursement

  • Type of Insurance Policy. – The patient’s insurance may be covered either by a federally funded program such as Medicare or Medicare or a private insurance program. …
  • The Nature of the Disorder. …
  • Who is Performing the Evaluation. …
  • Medical Necessity. …
  • Length of Treatment.