Denial Code CO-252: Managing Charges Above Allowed Amount

Denial Code CO-252 can create significant obstacles in your billing and reimbursement processes. This code indicates that a claim has been denied because the billed charges exceed the amount allowed by the payer. Effectively managing CO-252 denials is crucial for maintaining a healthy revenue cycle and ensuring that your practice is reimbursed accurately for the services provided. In this blog, we’ll explore the nature of CO-252, offer actionable strategies for addressing these denials, and provide tips for preventing them in the future.

What is Denial Code CO-252?

Denial Code CO-252 signifies that the claim was denied due to billed charges exceeding the payer’s allowed amount. This typically occurs when the amount billed for a service surpasses the maximum amount the payer will cover based on their payment policy or fee schedule.

Why Does CO-252 Matter?

CO-252 denials can significantly impact your practice’s revenue by causing delays in payment and increasing administrative work. Addressing these denials efficiently is essential to reduce revenue loss, streamline billing operations, and ensure proper reimbursement for the services you provide.

Deconstructing a CO-252 Denial: What Went Wrong and How to Fix It

Example:

• Initial Billing:some text
  • CPT 97112: Neuromuscular Reeducation

• Outcome: The claim was denied under CO-252 because the billed amount exceeded the maximum allowable amount set by the payer.

Remedy:

1. Review the Allowed Amount: Check the payer’s fee schedule or payment policy to determine the allowable amount for the billed service.
2. Adjust Billed Charges: Correct the billed amount to comply with the payer’s allowed amount.
3. Resubmit the Claim: Submit the corrected claim with the adjusted charges to align with the payer’s allowable amount.

• Corrected Billing:some text
  • CPT 97112: Neuromuscular Reeducation (billed at or below the allowed amount specified by the payer)

Actionable Steps: How to Address a CO-252 Denial

1. Analyze the Denial: Examine the Explanation of Benefits (EOB) or Remittance Advice (RA) to understand why the claim was denied as exceeding the allowable amount.
2. Verify Allowable Amounts: Review the payer’s fee schedule or payment policy to confirm the maximum allowable charges for the billed services.
3. Correct and Resubmit: Adjust the billed amount to meet the payer’s allowed limits and resubmit the claim for processing.
4. Review Billing Practices: Ensure that your billing practices align with payer policies to prevent future denials.

Common Causes of CO-252 Denials

1. Billed Amount Exceeds Limits: Billed charges that are higher than the amount the payer is willing to cover.
2. Incorrect Fee Schedules: Using outdated or incorrect fee schedules that do not reflect current payer limits.
3. Non-Compliance with Payer Policies: Failure to adhere to payer policies regarding billing limits and service charges.

Proactive Prevention: Avoiding CO-252 Denials

Pre-Claim Submission Checklist:

• Verify Allowable Charges: Confirm the allowable amount for services based on the payer’s fee schedule or policy before submitting claims.
• Update Fee Schedules: Regularly update your fee schedules to reflect the latest payer policies and allowable amounts.
• Double-check Billed Amounts: Ensure that billed amounts are accurate and within the limits set by payers.

Training and Best Practices:

• Train billing staff on understanding and applying payer fee schedules and payment policies.
• Develop protocols for verifying allowable amounts before submitting claims to avoid exceeding limits.

Technology and Tools:

• Use billing software that integrates with payer fee schedules to automatically check billed amounts against allowable limits.
• Implement claim scrubbing tools that identify potential issues with billed amounts before submission.

Conclusion: Effectively Managing CO-252 Denials to Protect Your Practice’s Revenue

Denial Code CO-252 can be a significant challenge, but with a clear understanding of payer limits and proactive billing practices, your practice can navigate these denials effectively. By verifying allowable amounts, updating fee schedules, and ensuring compliance with payer policies, you can minimize the impact of CO-252 denials and maintain a strong revenue cycle.

Optimize Your Billing Process with SPRY

Handling CO-252 and other complex billing issues can be streamlined with the right tools. SPRY’s advanced billing software is designed to help you verify allowable amounts, manage fee schedules, and prevent denial issues. Ready to improve your revenue cycle management? Schedule a demo with SPRY today and discover how our solutions can support your practice’s financial health.

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