It is not uncommon to encounter CO-24 when filing a claim submission to Medicare or Medicaid. CO-24 refers to a contractual obligation adjustment, and it often means that the payer rejected the claim because of specific coverage limitations. CO-24 denial code is essential to notice and react to recover your payments. In this article, we’ll discuss the CO-24 denial code and what to do when you encounter it.
CO-24 Denial Code Description
The CO-24 denial code is applied to show that a claim made has received a denial due to the patient’s insurance coverage under a capitation agreement or managed care plan. It may sometimes be referred to as a denied miscellaneous payment.
The CO-24 denial code reason depends on the scenario. For example, in some situations, the provider may have already requested payment for this service as a component of another claim. In the alternative, this code implies that the service should have been applied to a bundled payment rather than billed in a separate exchange.
Potential reasons for CO-24 denial codes include:
- Non-medical necessity of the service based on the patient’s diagnosis and treatment plan
- Lack of pre-authorization
- Service excluded in policy
A Real-Life Example: When Does CO 24 Denial Code Happen?
Consider this scenario better to understand your potential CO-24 denial code reason. Your patient is receiving care under a fixed, pre-payment arrangement. This could be for a surgery or a treatment for an illness. This plan requires you to provide services for a set number of days, no matter how many follow-up appointments the patient has.
Instead of properly coding a secondary follow-up appointment as a component of the fixed, pre-payment arrangement, your coder bills the payer separately for this appointment. This will likely generate a CO-24 denial code, noting that the service was a part of the bundled payment arrangement.
In this situation, it is critical to note:
- Improper coding is likely to have led to this incident
- A lack of training in your team related to the types of services included in the care you provide is likely
- The pre-fixed rate may be too little to cover your costs for multiple appointments
The Solution to CO-24 Denial Code
The CO 24 denial code solution is dependent on the scenario. Typically, it is possible to appeal this decision if you can demonstrate that the error is inaccurate with new or further information. You have 180 days to appeal this claim to seek out a solution. Also consider:
- Verify insurance information prior to submitting a claim
- Ensure that your team understands coverage for the care provided based on Medicare coverage
- Ensure the coordination of benefits (COB) is updated routinely
- Improve documentation processes within your organization
- Train and retrain employees who are providing code insights or turn to a team to handle this service for you to mitigate these risks.
Just like with CO-97 denial codes or CO-197 denial codes, the most effective way to not have to find a solution is to implement billing software and improve your workflow and documentation practices.
How Adonis Helps with Denial Codes (Including CO-24)
Accuracy and proficiency are two of the most common factors that lead to success in medical billing. Whether your physical therapy practice receives a CO-252 denial code for lack of updated assessment records or you are facing a CO-29 denial code because you are filing a claim late, you can mitigate these risks by utilizing technology like Adonis.
Adonis streamlines the denial management process. It allows you to automate many of the most important tracking steps that minimize the risk of coding errors and supports you in your claim resolution efforts.
As a healthcare practice and a business, mitigating these risks streamlines revenue management and maximizes recovery. It also helps ensure that your practice can continue to provide services that your patients need.
