Payers errors are identified and logged and used in our forensic reports
Various payer errors lead to underpayments, with contractual items being a common source. One example is the inclusion of "annual escalators" in contracts that allow for payment rate increases. If payers base the payment on the previous year's rate, providers may be underpaid. Another issue is when payers incorrectly bundle services, resulting in reduced reimbursement rates.
What We Do - IS UNHEARD OF AND PEERLESS
The healthcare industry faces challenges with handling underpayments due to staff inexperience, lack of prioritization, lack of familiarity with payer contracts, and inadequate technology. Many staff members are unaware that underpayments even occur and do not have the expertise to identify and manage them. Additionally, underpayments are often not prioritized, as staff members prioritize higher-dollar claims and denials.
Payment variance refers to the difference between the expected and actual payment made by providers and payers. It is crucial to address payment variances as payer underpayments can reduce provider revenue, while o
Underpayments can have a significant impact on provider income. For example, a physician group with 20 providers earning $14 million in net revenue per year could be missing out on $140,000 to $420,000 in annual in
Furthermore, in order to attract capital, new talent, or potential buyers, physician groups need to demonstrate a robust EBITDA (earnings before interest, taxes, depreciation, and amortization). When comparing figures
The complexity of patient billing in the healthcare industry is evident as provider groups receive payment from numerous insurance payers, each offering multiple plan types and benefit variations. Additionally, year
Even experienced billing staff may struggle to grasp the intricate details of a patient's current benefits. The shortage of healthcare workers, exacerbated by the COVID-19 pandemic and demographic factors, has resu
The remaining administrative team is burdened with a high volume of claims to process, resulting in work overload, burnout, and a higher likelihood of errors. Rushing through a large workload increases the chances of mistakes and underpa
Use our knowledge of complicated contracts and in house technology to verify your findings.
Lack of familiarity with payer contracts further complicates the issue, as providers typically have numerous contracts and lack the time to fully understand them. Finally, inadequate technology and resistance to change hinder the identification and management of underpayments.
Our agile dynamically built frameworks to provide spot on results
Many providers outsource contract management or use contract management software to track and compare payer contracts, but some fear a loss of control and transparency. Overall, addressing these obstacles is crucial to reducing underpayments and optimizing revenue in the healthcare industry.
Underpayments happen to every medical group but how do you react is the key
Payer-related sources of underpayments are often a result of mistakes or unfavorable contract language. The American Medical Association (AMA) reports that commercial health insurers have a 19.3 percent claims-processing error rate, which could save providers $17 billion if eliminated. AMA Board Member Barbara L. McAneny, MD, considers this error rate unacceptable and a waste of resources.
One Small miss Step compounds the problem
The major issue is right in front of us, yet it remains largely unnoticed. Merely a small portion of the data regarding underpayment can be found in variance reports. The vast majority of issues related to the revenue cycle are absent from these reports. Some of the items that can be seen on the payment variance report include stoploss, carveouts, annual escalators, bundling, and payment variance. Additionally, there are numerous false variances that are visible. Despite the significance attributed to variances, they often only account for a fraction of underpayments.
