You are losing up to ten percent of your collections if payer underpayments are not being aggressively pursued by your outsourced medical billing company. It is simply a minimum requirement of being in business that medical billing services compare your payments to the amounts your payers have agreed to pay you.
Any medical billing process must include features that are specifically designed to counteract the actions taken by payers to withhold money from medical practices and facilities. Examples of these features include: comparing claims to payers adjudication rules before submission, calling on submitted claims that have not been denied or paid, posting all payment information - including denials, pursuing underpayments, and using predictive payment estimates in the patient collection process.
Pursuing underpayments is the focus of today's article. This pursuit begins first and foremost with comparing the payment information from EOBs to the allowables outlined in the practice's payer contracts. This comparison must be done in an automated manner and cannot rely upon payment posters catching the underpayments on their own.
The reason that comparison to allowables must be automated is because of the clever and systematic manner in which payers typically underpay claims. These underpayment patterns can be difficult to spot, but one of the advantages a Medical Insurance Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical claims billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss.
As billing companies look across multiple clients they will frequently see the exact same CPTs being underpaid by the same amount by the same payer in a given month across all of their clients. The following month they will see the same payer switch to underpaying a different set of CPTs.
Although the amount of the underpayments may be small ($5 to $15), the totals can be quite large: upwards of a 10 percent net reduction in the payments the payer sends the practice. Despite the magnitude of the total, the constant hopping from CPT to CPT for underpayments and the relatively small amount of the underpayment on any individual claim makes the loss of revenue hard to spot - let alone pursue.
The pattern outlined above is why it is critical that a strategy for pursuing underpayments is not based upon payment posters picking up on the underpayments. Most payment posters will notice a large underpayment, but it is too much to expect them to spot a $5 underpayment.
This single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed by your medical billing service.
Identifying the underpayments is the first step of the journey. Dogged pursuit of the underpaid amounts is what actually drives up your practice's revenue. This pursuit needs to go down to even small underpayments because once a payer sees that the small underpayments are being pursued they typically taper off and contractual payments resume at the appropriate level. Much like a small child, the insurance companies are trying to see what the can get away with.
Copyright 2008 by Carl Mays II
Related posts:
- Tips For Getting An Attorney Medical Malpractice When you are looking for an attorney medical malpractice group,...
- Coders And Medical Billers Cover Letters You're Name You're Address Your City, State, Zip Code Your...
- How To Write The Perfect Medical Sales CV The medical & pharmaceutical retail sector employs millions of people...
- The Bottom Line: What On Earth is Certified Medical Transcription? Many people studying to become medical transcriptionists often ask this...
- Making Good Medical Choices Your future is not already written. This is a wonderful...