Why Medical Claims are Denied?

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By Eric Duchinsky

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One Doctor’s POV

Hi Ann,

Dr. Nicholas Fogelson wrote a perspective article for KevinMD.com. He wrote about his experience as a peer reviewer for an independent review organization network. The observations hit to the heart of why third-party peer review (for payers) and physician advisor services (for providers) are vital for building efficiencies.

The categories

Here are the main categories Dr. Fogelson saw while reviewing:

  • Full-spectrum medicine
  • Poor documentation
  • Industry acceptance of something that cannot be supported in the literature or not evidence-based.

Assessment

The takeaway lessons, from Dr. Fogelson’s observations, point to two very fixable inefficiencies: better documentation and following evidence-based research for care.

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Click HERE for the follow-up blog on more reasons claims are denied. 

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Conclusion

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