Outsourced Medical Billing must pursue underpayments
by: CarlMaysII | Total views: 9 | Word Count: 498 | View PDF | Print View
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.
Today's focus will be on pursuing underpayments. The first step of this pursuit is comparing a practice's Explanation of Benefits from the payers to the amounts the payers have agreed to pay for each procedure. Many billing processes assume the payment posters will catch these underpayments; this is a bad assumption. The billing process must have an automated comparison process.
Payers have adopted underpayment techniques that are too difficult for a payment poster to spot on their own. Medical billing companies can design their process to battle payers underpayment techniques because they have an advantage over individual practices - they see EOBs for a given payer across multiple practices and multiple states. The enhanced scope allows medical billing services that pay attention to identify patterns that might be overlooked by individual medical practices.
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.
These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount "under the radar" can make the underpayments difficult for an individual practice to spot.
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.
What does all of this mean to your top line? A medical insurance billing service that properly implements the pursuit of underpayments can increase your revenue by between 5 and 10 percent - and this is pure profit.
Spotting the underpayment is only part of the battle, of course, the billing service also needs to have a systemic process in place for pursuing the underpayments. It is critical to pursue event the small underpayment amounts. Once a payer sees that their resources are being tied up readjudicating claims because of a $5.00 underpayment, the underpayments will often cease to happen.
Copyright 2008 by Carl Mays II
About the Author
Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent the past 15 years improving the financial performance of his clients. To learn more about what to look for in Medical Insurance Billing Services subscribe to Carl's blog
Rating: Not yet rated
Login to vote
