I was recently working with a new client and noticed something out of sorts – their collection percentage higher than usual. This made me delve deeper. I suspected that their billed charges were so low that they were probably receiving payments from some insurance carriers at or near 100% of what they charged — and I was right! I pulled EOBs from all carriers, reviewed them one at a time and made a list of each instance where a visit code was reimbursed at 100% of the billed charge.
The results were alarming; just imagine how much money was left on the table simply because fee schedules weren’t aligned with allowed reimbursements, especially when the contracted reimbursement rate was in black print! One of the contracts had been recently renegotiated, but no one took the time to review the billing system fee schedule to ensure the allowable rates would be paid. If you bill a lower fee than the allowable reimbursement, that’s ALL you’ll receive. Lesson learned in this situation. Review your fees quarterly and keep your eye on the ball!