According to the AMA, twenty percent of
claims are not paid correctly (http://www.ama-assn.org/ama/pub/news/news/ama-health-insurer-report-card.page). According to their calculations, that results in $17 BILLION DOLLARS IN WASTE every year.
The costs to a medical practice aren't just the lost revenue from lower than contracted reimbursements, it's all of the added administrative time spent reviewing claims, fighting with the insurance companies, and exchanging information.
It's now possible to use advanced technology to scour data in electronic EOB forms to compile all of the CPT codes and the corresponding reimbursements and compare those to the contracted amounts with your payers. Once that information is available, it's easy to calculate how much you've been underpaid.
The key to recovering the underpayments is having an experienced attorney that knows the ins and outs of the insurance industry and can do battle with the insurance companies on your behalf.
This process doesn't cost anything to the medical practice, they simply share a portion of the recovered revenue. Once the reimbursement process is tightened up, it will result in increased revenue and profitability by reducing the amount of staff time spent reviewing receivables.
If you'd like more information, please contact Glenn Odell at 503-715-0284.
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