Medical billing requires effective management of denials to ensure timely reimbursements, and minimize financial disruption for healthcare providers and patients. When a healthcare insurer reviews a claim, they may refuse to pay for requested services. Denials are different from rejections, which occur because of mistakes or discrepancies with the claims data. They can be due to insufficient documentation, insufficient medical necessity or incorrect coding. Denials of medical billing can be a major challenge for healthcare providers. They may lead to administrative headaches, delays in payments, and even financial losses. Outsourced medical billing services are an excellent way to prevent denials and maintain a healthy revenue cycle.

This article will explain the difference between denials and refusals of claims, the most common causes and types of denials as well as how to avoid them.