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Blog Posts

service claims paid at 100% of your charges?

1/7/2018

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Insurance Payment Allowed 100% of Charged Amount  is not something to celebrate! 
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I asked some of my readers about how they will feel if their claims has an allowed amount that is at 100% of the charged amount, wow!
So, meaning, when you bill for $2000.00 and the insurance made their determination at 100% of your charges… you bill $2,000, they allowed $2,000 – would you be happy?
Honestly, if I see EOB like this, I will be very very nervous! Your provider could have been paid more than the practice submitted charges, isn’t it?

Interestingly, most of my readers said they’ll be happy if they were paid at 100% of their charges… now, would you?

What if the allowed amount could have been $2,500? – how much is the difference? Yep, $500! How can the payer allow $2,500 if you have only submitted a charged amount of $2,000?!
Make sense?

Ok, now, here’s the deal! — if you got paid at 100% based on your charged amount you should find out about your fee schedule or contracted rate or what is usual and customary if you are out of network provider. Make sure you know you are not under-charging the insurance payer.
But what if you have realized that you did under-charge the insurance payer? what will you do? can you recover the money that you could have been paid for? The answer is YES! you can recover that money!
Now, don’t wait too long! Take action immediately!

Based on my experience, you can go back as far as 3 years from the date the claims were paid. I haven’t tried more than 3 years of claim to recover due to undercharges! After all, just like the insurance payer, they can always go back as far as more than 3 years I think to recover overpayments. Or depending on where state you are located.
Pay attention on your EOBs! I think that’s the key. As soon as you discover there is an undercharging and you were paid 100% on your charged amount. Pick up the phone and call that insurance payer immediately.
Connect with us today, we will show you better strategies on how to run an effective revenue cycle management!
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    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio, MSC, CSPPM, CRCR, CSBI, CSPR, CSAF is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    Current HFMA Professional Expertise Credentials: 
    HFMA Certified Specialist in Physician Practice Management (CSPPM)
    HFMA Certified Specialist in Revenue Cycle Management (CRCR)
    HFMA Certified Specialist Payment & Reimbursement (CSPR)
    HFMA Certified Specialist in Business Intelligence (CSBI)

    View my Profile on Linkedin
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  • About
    • In the News
    • Privacy Policy
    • Terms of Use
  • Leadership
  • Contact Us
  • Testimonials
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division