Even with appropriate, timely documentation, it’s all too common for EDs to receive an inaccurate, lower payment from the payer, according to Jeffrey Bettinger, MD, FACEP, founder of Bettinger, Stimler, & Associates, a Pinecrest, FL-based organization specializing in health care reimbursement. "There needs to be a detailed system in place to catch these underpayments and to effectively attempt to collect the balance owed," he says.
Here are two solutions for this:
1. Using a billing software system programmed to display the expected payments for each charge.
This is a time-consuming process that needs to be performed every year, Bettinger says. For all payers, the contracted amounts, per individual charge code, need to be loaded into the system, he says. Then, when a payment is being posted on the billing system, the payment poster has instantaneous capability to assess whether the remitted payment is correct, he adds. "Some billing agents have even gone so far as blocking the posting of any payment that does not meet the preset expected payment amount for the individual charge code," he says.
2. Creating a spreadsheet that lists the expected payment amounts for all contracted payers.
This method can be used if your software system doesn’t have the capability to display expected payments, suggests Bettinger. "Unfortunately, if the payment poster does not have access to the expected payments, underpayments often will be accepted as correct, with corresponding inaccurate adjustments to the invoice," he notes.