Unraveling Denial Code 171: A Guide to Provider and Facility Alignment for Healthcare Providers

Don't Let Denial Code 171 Disrupt Your Revenue Cycle
Receiving a denial code 171 on your healthcare claims can be frustrating and costly.  This code signifies a mismatch between the provider type and the facility where the service was rendered. Understanding why this happens and how to prevent it can significantly improve your claim acceptance rate and overall financial health.

Understanding Denial Code 171
Denial code 171 arises from discrepancies between the provider's qualifications, the facility's type, and the service billed. Common scenarios include:

• Place of Service Mismatch: The service is not covered when performed in a particular location, like billing an inpatient procedure conducted in an outpatient setting.
• Provider Qualifications: The provider lacks the necessary credentials to perform the service in that specific facility.
• Facility Certification: The facility may not have the required certifications or licenses to support the service billed.
• Coding Errors: Incorrect or missing procedure codes and modifiers can also contribute to the denial.
• Duplicate Billing: Billing the same service multiple times for the same patient.

Strategies to Prevent Denial Code 171
By implementing these proactive measures, you can significantly reduce denial code 171 occurrences:

• Comprehensive Provider Credentialing: Ensure all providers hold the appropriate licenses, certifications, and privileges to perform services within your facility.
• Adherence to Payer Guidelines: Stay up-to-date on each payer's specific rules regarding the provider and facility types eligible for reimbursement for certain services.
• Accurate and Detailed Documentation: Maintain comprehensive medical records that clearly document the provider's qualifications and the facility's role in delivering the care.
• Rigorous Coding and Billing Practices: Implement robust coding and billing guidelines with regular audits to prevent errors.
• Effective Claim Review: Scrutinize claims for accuracy before submission to identify potential denial triggers like coding mismatches or missing information.
• Strong Payer Relationships: Build positive relationships with payers to facilitate clear communication and efficient solutions to claim rejections.

The Financial Impact of Denial Code 171
Denial code 171 can have a significant financial impact. Delayed payments, increased administrative costs associated with appealing denials, and reduced revenue due to unapproved claims can strain your practice's resources. By taking preventative measures, you can improve your claim acceptance rate and overall financial performance.

Conclusion
Preventing denial code 171 requires a multi-pronged approach that focuses on meticulous attention to provider qualifications, facility certifications, and accurate coding procedures. By understanding the common causes and implementing proactive steps, healthcare providers and practice managers can optimize their revenue cycle management and improve patient care without the disruption of claim denials.

Looking for Additional Support?
Claims Med can help you navigate the complexities of healthcare billing and coding. Our team of experts can assist with provider credentialing verification, payer guideline updates, and claim review to minimize denials. Contact Claims Med today and let us help you optimize your revenue cycle.