Getting Paid What You’re Due
Studies show that practices are routinely underpaid on their fee for service claims in government and commercial claims. In our fast paced payment posting world, where hundreds and thousands of line items are posted from a single electronic remittance file, a human is often not even able to see what would otherwise be obvious. So, how can anyone be certain that their claims have been adjudicated correctly and that the practice hasn’t been short changed? Even if you look at your data regularly, knowing whether you are getting paid for the services you bill out if difficult because no two payers process claims exactly alike. Each payer uses proprietary rules from ranking of RVUs, to which CPT code is in what order on the claim form and then modifies the payment based on the place of service, whether a provider is [...]
