Compliance: Utilize This MAC's Top 2018 Denial Reasons for Clean Claims

Why This Topic Matters

Understanding these denial patterns can help practices reduce returned claims, support cleaner billing workflows, and keep coding systems aligned with annual code revisions and payer expectations.

Article Sections

1. Procedure Code Was Invalid on the Date of Service

   This section discusses claim denials tied to reporting codes that were not valid for the service date and emphasizes monitoring annual code updates. It also notes the importance of keeping systems current with code changes.

2. Similar E/M Services Performed by Multiple Providers in Same Group

   This section covers denial issues that can arise when more than one clinician in the same group sees the same patient. It addresses general E/M reporting considerations within group practice settings and mentions subspecialty-related distinctions.

3. Reporting A Service Without First Billing Its Prerequisite

   This section explains denial risk when a service is reported without the required preceding service or procedure. It discusses general CPT reporting dependencies and add-on code relationships.