|
|
Insurance Underpayements -- It's More Common Than You Think
Are you sure your insurance companies are paying you according to your contracts? You may be surprised to know that it's unlikely that they are. The average medical practice loses approximately five to ten percent of their collections because most insurance underpayments are never pursued or even identified.
Recently, a National Health Insurer Report Card was compiled by the American Medical Association. The AMA looked into the payment performance of the following big payers -- Medicare, Human, Aetna, United Healthcare, Anthem BCBS, Cigna, and Coventry. To certain extents, each payer underpaid practitioners regularly.
The worst of the lot was United Healthcare, which failed to pay contracted rates in 38.4% of their cases. Cigna was the second-worst performer, underpaying 33.8% of their cases. Aetna followed at third place (29.2%), then Anthem BCBS (27.9%), Humana (15.8%), and then Coventry (13.3%). Even Medicare underpaid 2% of their cases.
It's not easy tracking these underpayments. If you look across different medical practices, you'll find the exact same CPTs getting underpaid at around the same amount by the same payer during the same month. But the next month, you may notice the payer switching to a different group of CPTs.
These under payments are not huge 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 this difficult for an individual practice to spot.
It is also difficult for a medical billing service to spot if they are not comparing your payments to your contracted rates (and dealing with multiple procedure complexities properly). The process of properly maintain and utilizing multiple, complex allowable tables is extremely difficult.
Any billing service (or stand-alone medical practice) needs to acquire and fully use industry technology to find and pursue underpayments. Most systems being used today are woefully ill-prepared to handle such cases -- a good system should effectively manage, identify, and pursue these underpayments, but most systems fail in at least one of these areas. It's a truly complex task that's difficult to manage.
But it's still very important to try solving the problem. Merely comparing payments to allowables can increase your practice's revenues by 5-10%. Of course, you'll need a strong process, some really good reporting technology, and a methodical way to track complex procedures. Done correctly, you'll add thousands of dollars to your practice's profits.
2009 copyright by Carl Mays II
About the Author Carl Mays is President and Founder of ClaimCare, a medical billing company that services clients across the nation. Carl is an expert in medical billing and physician revenue cycle management. He has an MBA from Wharton and a BSE from Princeton University.
|
 |
Please Rate: |
|
Rating: |
 Processing ... |
(Average: Not rated) |
| Views: | 33 | |
|
| More Articles from Human Resources | | |
| Top Articles in Human Resources | | |
|
