October 04, 2017
At times, just getting paid by the insurance companies feels like a victory. However, it’s important to ensure that the payments you’re receiving are correct according to your contract. There are a few ways to check:
We have found that most practices find a discrepancy of up to 10 percent on some payments. That’s a large number when extrapolated across a year for a procedure code that is performed on a regular basis.
For example, take a look at what 10 percent looks like on just 100 99214’s a month:
|Code||Units/month||Annualized||Contract Amount||Paid Amount||Difference/unit||Total Revenue Found|
Contract analysis also allows you to see what codes are being paid on an aggregate basis. It helps answer questions such as:
Now that you’ve found discrepancies on a payment, what do you do?
Depending on the number and the amount of the discrepancy, you may want to contact an insurance claim representative or take the list of incorrectly paid claims to your provider relations. Either way, make sure that you have all the information about your contract and the exact claims you want reviewed. Be ready to follow up to resolve it fully.