Medical billing companies have a lot of responsibilities, from submitting medical claims to insurance companies to resubmitting denials and processing billing collections. Sometimes the jargon can be overwhelming, due to the vast tasks that are required and the terminology-heavy industry. So when it comes to medical billing, what exactly is the difference between a rejection and a denial?

What is a Rejection in Medical Billing?

Medical billing companies know that a rejection cannot begin to be processed because it does not meet the basic requirements or contains an error. These errors are usually coding errors or mismatched procedures. It can, however, be corrected and resubmitted at any time with ease since the information hasn’t yet been received or entered into the system. As the services are not actually being billed in a rejected medical claim, the beneficiaries cannot be held liable. 

What is a Denial in Medical Billing?

A denial cannot be resubmitted because the payment details have already been decided upon, but have been marked as unpayable due to errors discovered after the claim was filed. These errors are typically inaccurate information or insufficient coverage. Denials can, however, be appealed if followed up with the appropriate paperwork detailing why it was denied and how this is to be rectified. Whilst it’s possible to appeal a denied claim, it’s commonly seen as a duplicate so the process can be lengthy and complicated.

Effects Rejections and Denials Are Having On Your Revenue Cycle

Knowing the difference between rejections and denials not only saves time but also important resources. Using denials and rejections, a medical billing company can review where there are flaws and improve upon the service. For example, if they process a lot of denials, it’s beneficial to examine that process and develop strategies to reduce the number of denials. 

Rejections and denials can be difficult to navigate and although many medical professionals use those two terms synonymously, it’s important to recognize the differences and the impact it can have on your corporation. CHRM can help provide medical billing online, reach out to us to see what we can do to help you navigate medical claims.