A Healthcare Operations Consulting Company, Coding and Documentation Reviews Audits, Utilization Prior Authorization, Credentialing, Patients Access and Healthcare Financial Management Consulting Company | GoHealthcare Consulting and Business Development,
  • Who We Are
  • Services and Expertise
  • Testimonials
  • CONTACT US
  • BLOG
  • Readers Questions
  • Read More
  • Resources

service claims paid at 100% of your charges?

1/7/2018

0 Comments

 
Insurance Payment Allowed 100% of Charged Amount  is not something to celebrate! 
Picture
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!
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Picture
    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio 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 Consultant.

    READERS QUESTIONS

    search here


    RSS Feed

    Archives

    January 2021
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    April 2020
    March 2020
    December 2019
    February 2019
    August 2018
    February 2018
    January 2018
    December 2017
    September 2017
    August 2017
    June 2017
    May 2017
    February 2017
    October 2016


    Categories

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Medical Modifiers
    Pain Management Billing
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder

    RSS Feed


    BROWSE HERE

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Medical Modifiers
    Pain Management Billing
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder


Services:
Full Revenue Cycle Management 
98% of the time your claims can get paid
Cash flow increase up to 35% in 90 days
​Accounts Receivables Management
Denial Management
Motor Vehicle Cases
Workers Compensation Cases
Prior Authorization Process
Coordination of surgical orders management
Prior-to-insurance eligibility and coverage verification
Utilization and medical policy review
Medical necessity evaluation and screening
Financial clearance process
Patients Access ​
​Patients Registry and Initial Demographic Entry
Patients Scheduling and Confirming Appointments
Coordination of prior-to-encounter orders management
Prior-to-encounter insurance verification
Obtaining Referral 
Obtaining Prior Authorization
Obtaining Peri Operative Orders
Financial Counseling
Insurance Credentialing and Contracting
Payers' Contract Fees Negotiations
Documentation Review
Evaluation and Management Coding Review
Surgical Coding Review
Compliance Program
Office and Surgical Scheduling
(small or huge organization we can easily help you!

Picture

CALL US TODAY:  1 (800) 267-8752
© COPYRIGHT 2019 GoHealthcare Consulting and Business Development LLC. ALL RIGHTS RESERVED.
  • Who We Are
  • Services and Expertise
  • Testimonials
  • CONTACT US
  • BLOG
  • Readers Questions
  • Read More
  • Resources