What might happen to a claim that is submitted with inaccurate CPT codes?

What might happen to a claim that is submitted with inaccurate CPT codes?

• A. It will be automatically approved
• B. It may be denied or delayed in processing
• C. It will go through expedited processing
• D. It will incur no repercussions

Answer: (B)

When a claim is submitted with inaccurate CPT codes, it may be denied or delayed in processing. Insurance companies rely on precise and accurate coding to determine the medical necessity of procedures performed, as well as their appropriateness for payment. If the codes do not match the services provided, the claims processing system may flag the submission for further review or reject it outright. This can lead to delays in reimbursement for the healthcare provider or even require the provider to submit corrected claims, creating additional administrative work and potential cash flow issues. Accurate coding is essential in ensuring that claims are processed efficiently and correctly.

When a claim is submitted with inaccurate CPT codes, it may be denied or delayed in processing. Insurance companies rely on precise and accurate coding to determine the medical necessity of procedures performed, as well as their appropriateness for payment. If the codes do not match the services provided, the claims processing system may flag the submission for further review or reject it outright. This can lead to delays in reimbursement for the healthcare provider or even require the provider to submit corrected claims, creating additional administrative work and potential cash flow issues. Accurate coding is essential in ensuring that claims are processed efficiently and correctly.