While the numbers vary a bit, industry experts across the board agree that unpaid – and underpaid – medical claims amount billions of dollars in lost revenue for healthcare practices and organizations each year. Some reports estimate that an average of around 5.5% of claims are simply unpaid by insurers for various reasons – imagine 5 of every 100 patients that you see simply not being paid on! The amounts add up, and deliver heavy negative financial impacts to practices.
At a time when increasing patient responsibilities (and the difficulty in collecting them) are becoming a mounting issue for providers, freeing your staff from the manual work of eyeing every EOB and ERA line item, and making sure that you’re collecting every penny from your payer contracts is crucial. Read up on some of Genesis RCM’s Tips to Avoid Underpayment.
Examine Contracts – and if needed, Renegotiate
An experienced biller or RCM partner will be able to review and assess your current contracts to provide feedback on which payers you should consider exploring a contract renegotiation. Everything from fee schedules, to contracted rates and and patient expense estimations should be reviewed to help determine if there is an opportunity to create a better scenario, payer by payer.
Correct Coding, The First Time
Proper coding (and billing) procedures upfront make for a much cleaner, faster claim submission and adjudication process. Making sure that your billers or RCM partners have not just a healthy understanding of your practice’s fee schedules and contracts, and the codes themselves, but of the various nuances among payers and code modifiers, is important to improving your first pass success rates, and ultimately proper payment amounts. Ongoing training and education opportunities for billers and coders are excellent ways to ensure the best results in the long term at your practice.
Reallocate the Responsibilities
In a perfect world, getting coding right the first time would be easy. This, however? Is not a perfect world. Medical billing is detailed work, requirements are nuanced from payer to payer, and countless hours are lost by practices to their billings having to eyeball each and every line item, of each and every ERA to ensure proper payment. If you recognize this is an issue in your practice, consider outsourcing your coding and billing workflows to an RCM partner who can work as an extension of your team, alleviating stress for your staff and utilizing industry-proven best practices to better your coding results.
Recover What’s Owed
If you’re concerned (or know) that underpayment or nonpayment is an issue with any of your contracts, a Recovery Project can be a highly impactful project to outsource. Genesis RCM Underpayment Recovery Services begin with a detailed analysis of your paid claims, allowable and fee schedules to identify variances and flag appropriate encounters for potential underpayment recovery opportunities. We review those results with our clients to validate those that are truly eligible for refiling or appeal, and then work to process those to recoup what’s owed to the practice.
To learn more or to receive a free Underpayment Recovery Opportunity Analysis, contact Genesis today!