Denial code 135 is an indication that interim bills cannot be processed. This means that the healthcare provider has submitted a bill for services that were provided in multiple stages or over a period of time, but the payer is unable to process the bill at this time. It could be due to various reasons such as missing documentation, incomplete information, or specific billing guidelines that need to be followed for interim billing.
Common causes of code 135 are:
1. Missing or incomplete patient information: If the patient's demographic or insurance information is missing or incomplete, the interim bill may not be processed. This can include missing or incorrect patient name, date of birth, address, or insurance details.
2. Lack of documentation: Interim bills require proper documentation to support the services provided. If there is a lack of documentation, such as missing progress notes, treatment plans, or other required medical records, the bill may be denied.
3. Incorrect coding: If the services provided are not coded correctly, it can lead to a denial. This can include using incorrect procedure codes, diagnosis codes, or modifiers. It is essential to ensure accurate coding to avoid denials.
4. Timeliness issues: Interim bills must be submitted within a specific timeframe, as per the payer's guidelines. If the bill is submitted late or after the allowed timeframe, it may be denied.
5. Duplicate billing: Submitting multiple interim bills for the same services can result in denials. It is crucial to avoid duplicate billing and ensure that only one bill is submitted for each service rendered.
6. Non-covered services: Some services may not be covered by the patient's insurance plan. If the interim bill includes non-covered services, it may be denied. Verifying insurance coverage and communicating with the patient about potential non-covered services can help prevent denials.
7. Lack of medical necessity: Interim bills must demonstrate medical necessity for the services provided. If the payer determines that the services were not medically necessary, the bill may be denied. It is important to document and communicate the medical necessity of the services to avoid denials.
8. Coordination of benefits issues: If the patient has multiple insurance plans, coordination of benefits issues can arise. This can include incorrect primary/secondary insurance information or failure to follow the coordination of benefits guidelines. Ensuring accurate coordination of benefits information is crucial to prevent denials.
9. Payer-specific requirements: Each payer may have specific requirements for interim billing. Failure to meet these requirements, such as missing specific forms or documentation, can result in denials. Familiarizing yourself with each payer's guidelines and ensuring compliance is essential.
10. System or technical errors: Sometimes, denials can occur due to system or technical errors. This can include issues with the billing software, electronic claim submission, or data transmission errors. Identifying and resolving these errors promptly can help prevent denials.
Ways to mitigate code 135 include:
- Ensure timely submission: Submit interim bills promptly to avoid delays in processing. Implement a streamlined process to capture and submit interim billings as soon as they are ready.
- Accurate documentation: Ensure all necessary documentation is complete and accurate before submitting interim bills. This includes providing detailed information about the services rendered, dates of service, and any supporting documentation required.
- Clear communication: Maintain open lines of communication with payers to address any questions or concerns regarding interim bills. Promptly respond to any requests for additional information or clarification to prevent unnecessary delays.
- Monitor claim status: Regularly monitor the status of interim bills to identify any potential issues or delays. Implement a system to track the progress of claims and follow up on any outstanding or pending claims.
- Stay updated with payer policies: Stay informed about the specific requirements and policies of each payer regarding interim bill processing. Regularly review and update internal processes to align with payer guidelines and prevent potential denials.
- Educate staff: Provide comprehensive training to staff members involved in the billing process to ensure they are aware of the specific requirements and best practices for submitting interim bills. Regularly update training materials to reflect any changes in payer policies.
- Utilize technology: Leverage technology solutions, such as revenue cycle management software, to streamline the billing process and minimize the risk of denials. These tools can help automate claim submission, flag potential errors, and provide real-time updates on claim status.
- Conduct regular audits: Perform regular audits of the billing process to identify any recurring issues or patterns that may lead to denials. Use the findings from these audits to implement corrective actions and improve overall billing accuracy.
By implementing these strategies, healthcare providers can mitigate code 135 and reduce the likelihood of denials related to interim bill processing.
The steps to address code 135, "Interim bills cannot be processed," are as follows:
- Review the billing process: Ensure that the interim bill was submitted correctly and all necessary information is included. Check for any missing or incorrect data that may be causing the code 135 denial.
- Verify eligibility: Confirm the patient's eligibility for interim billing. Check if the patient's insurance plan allows for interim billing and if there are any specific requirements or limitations.
- Communicate with the payer: Reach out to the insurance company to understand the reason behind the denial. Ask for clarification on their policy regarding interim billing and if there are any specific steps or documentation required for successful processing.
- Update the claim: Make any necessary corrections or additions to the claim based on the information obtained from the payer. Ensure that all required fields are completed accurately and any missing information is included.
- Resubmit the claim: Once the necessary changes have been made, resubmit the claim to the payer. Double-check that all the required documentation is attached and that the claim is submitted within the specified timeframe.
- Monitor the claim: Keep track of the claim's status and any communication from the payer. Follow up regularly to ensure that the claim is being processed correctly and to address any further issues that may arise.
- Appeal if necessary: If the denial persists or if the payer's response is unsatisfactory, consider filing an appeal. Gather any supporting documentation or evidence that may help overturn the denial and present a strong case for reconsideration.
Remember, each denial code may require different steps to address it effectively. It is crucial to thoroughly understand the specific denial reason and work closely with the payer to resolve the issue promptly.