Denial Code B14 means that only one visit or consultation per physician per day is covered. This denial code indicates that the insurance company will not make payment for multiple visits or consultations with the same physician on the same day. Below you can find the description, common reasons for denial code B14, next steps, how to avoid it, and examples.
2. Description
Denial Code B14 is a specific denial code that states that only one visit or consultation per physician per day is covered. This means that if a patient sees the same physician multiple times on the same day, the insurance company will only reimburse for one of those visits or consultations. It is important for healthcare providers to be aware of this code and understand its implications when submitting claims for reimbursement.
2. Common Reasons
The most common reasons for denial code B14 are:
- Multiple Visits with the Same Physician: Denial code B14 is triggered when a patient has multiple visits or consultations with the same physician on the same day. This could occur if the patient has multiple appointments scheduled or if there is a need for follow-up visits or consultations.
- Incorrect Coding: If the visits or consultations are coded incorrectly, it can lead to denial code B14. It is important for healthcare providers to accurately code the services provided to ensure proper reimbursement.
- Lack of Documentation: If there is insufficient documentation to support the need for multiple visits or consultations with the same physician on the same day, it can result in denial code B14. Healthcare providers should ensure that they have proper documentation to justify the medical necessity of each visit or consultation.
3. Next Steps
You can address denial code B14 by following these steps:
- Review the Claims: Carefully review the claims that have been denied with code B14 to identify the specific visits or consultations that were denied. This will help in understanding the reason for the denial and determining the appropriate next steps.
- Check for Coding Errors: Verify that the visits or consultations were coded correctly. If there are any coding errors, correct them and resubmit the claims for reimbursement.
- Provide Additional Documentation: If the denial was due to lack of documentation, gather the necessary documentation to support the medical necessity of each visit or consultation. This may include progress notes, test results, or other relevant information. Submit the additional documentation along with a request for reconsideration.
- Appeal the Denial: If the denial is not resolved through the initial request for reconsideration, you may need to file an appeal. Follow the insurance company’s appeal process and provide any additional information or documentation that supports the medical necessity of the multiple visits or consultations.
- Communicate with the Patient: Keep the patient informed about the denial and the steps being taken to address it. Explain the insurance company’s policy regarding multiple visits or consultations with the same physician on the same day and discuss any potential out-of-pocket costs that the patient may be responsible for.
4. How To Avoid It
To avoid denial code B14 in the future, consider the following:
- Coordinate Appointments: When scheduling appointments for a patient, ensure that there is sufficient time between visits or consultations with the same physician on the same day. This will help prevent the need for multiple visits or consultations and reduce the risk of denial.
- Accurate Coding: Ensure that visits or consultations are coded accurately, reflecting the specific services provided. This will help prevent coding errors that could lead to denial code B14.
- Thorough Documentation: Document the medical necessity of each visit or consultation, including the reason for the multiple visits or consultations on the same day. This will provide the necessary documentation to support the services provided and help prevent denial code B14.
5. Example Cases
Below are two examples of denial code B14:
- Example 1: A patient visits their primary care physician in the morning for a routine check-up and then returns in the afternoon for a separate issue. The insurance company denies the claim for the afternoon visit with denial code B14, as only one visit or consultation per physician per day is covered.
- Example 2: A patient sees a specialist for a consultation and then has a follow-up visit with the same specialist later in the day. The insurance company denies the claim for the follow-up visit with denial code B14, as only one visit or consultation per physician per day is covered.
