Explain how technology and human error may contribute

Reference no: EM133431345

Case Study: claims payer (also known as an insurance company) may deny claims based on individual line-item claim data. This denial generally happens for several reasons: intake errors on the front end during patient registration, mismatch with diagnosis and procedure coding documented by the health system, or technology issues. If the claim is denied, health systems are required to resubmit the claim, either by correcting the error(s) on the claim or submitting an appeal if they disagree with the denial. Insurance companies may require a resubmission of all original documents. This process is part of the revenue-cycle workflow of a healthcare organization.

Question: Explain how technology and human error may contribute to a denial by the insurance company.
Identify at least one internal process breakdown each from the front-end, middle, and back-end workflows that could lead to a claim denial.

Reference no: EM133431345

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