As a healthcare provider, getting a denial code 171 can be frustrating. It delays payment and puts stress on your revenue cycle. Denial code 171 typically indicates a mismatch between the provider type and the facility where the service was rendered. It’s important to know why this denial happens. You should also take steps to prevent it. This will help make billing easier and improve your practice’s financial results.
What is Denial Code 171?
Denial code 171 occurs when there are discrepancies between the provider’s qualifications, the facility’s classification, and the service performed. Common reasons for this denial include:
- Place of Service Mismatch: The service is being billed from a location that doesn’t meet the payer’s requirements (e.g., outpatient services billed as inpatient).
- Provider Qualifications: The provider may not have the appropriate credentials or certifications to perform the service in that facility.
- Facility Certification: The facility where the service is provided may not be properly certified or licensed to offer that service.
- Coding Errors: Mistakes in coding or missing modifiers can result in denials.
- Duplicate Billing: Submitting the same service multiple times for the same patient.
How to Prevent Denial Code 171
To minimize the risk of denial code 171, practice managers, healthcare providers, and owners should adopt the following strategies:
- Comprehensive Credentialing: Ensure that providers have the required licenses, certifications, and privileges for the services performed within the facility.
- Adhere to Payer Guidelines: Stay up to date with payer-specific requirements regarding the types of providers and facilities eligible for reimbursement.
- Accurate Documentation: Thorough documentation of the provider’s qualifications and the services provided will support your claims.
- Strict Coding Practices: Implement proper coding practices and conduct audits to catch errors early, reducing the chances of denial.
- Pre-Claim Review: Carefully review claims before submission to ensure they are accurate and complete.
- Build Relationships with Payers: Foster strong relationships with payers to address denials promptly and efficiently.
The Financial Impact of Denial Code 171
Denial code 171 can cause significant financial strain, leading to delayed payments, higher administrative costs, and revenue loss. By addressing the main reasons for denial, healthcare providers can speed up claim acceptance and improve revenue management.
Conclusion
Preventing denial code 171 requires ongoing attention to detail, including ensuring provider qualifications, complying with payer guidelines and adhering to accurate coding practices. By addressing these areas, healthcare providers can significantly improve claim acceptance rates and maintain healthier financials.
For expert help navigating complex claim denials and optimizing your billing processes, get in touch with Claims Med. Our team specializes in resolving denial codes efficiently and improving your overall billing success.