In the world of healthcare, it’s critical that every medical provider is fairly compensated for the services they offer. Unfortunately, many providers find that their claims are being underpaid, or worse, denied altogether. The consequences? A negative impact on revenue and the financial health of your practice. So, how do you know if your claims are being underpaid? What can you do about it? In this blog, we’ll explore some warning signs, solutions, and why choosing the right Medical Billing Service is key to ensuring you get what you deserve.
If you need the best Medical Billing Services, contact us now for expert assistance.
How to Know if Your Claims Are Being Underpaid
Red Flags to Watch for When It Comes to Underpaid Claims
Identifying underpaid claims can be tricky, but it’s essential for the financial health of your practice. Here are some common red flags to look out for:
1. Unusually Low Reimbursements for High-Cost Procedures
Do you notice that procedures such as major surgeries, comprehensive diagnostic tests, or advanced therapies seem to yield much lower reimbursements than expected? For instance, a surgery coded with CPT 47562 (Laparoscopic Cholecystectomy) should yield a much higher reimbursement than a routine procedure like a wellness check-up. If you see significantly lower payments for high-cost treatments, it’s a red flag that your claims may be underpaid.
2. Discrepancies Between Payer Contracts and Payments
Do the payments you receive match the terms outlined in your contracts with insurers? Many practices fail to compare the payments they receive to their payer contracts, resulting in consistent underpayment. Insurers may make errors in their payments, so it’s important to monitor contract compliance regularly.
3. Denials Without Proper Explanation
A clear explanation of benefits (EOB) or a remittance advice (RA) should accompany every denial or underpayment. If you’re receiving vague or incomplete reasons for reduced payments, it’s time to investigate. This could be due to coding errors or missed information, such as failing to use the appropriate ICD-10 code like J44.9 (Chronic Obstructive Pulmonary Disease, unspecified).
4. Increased Denial Rate
If you’re experiencing an unusually high number of claim denials, this could be a sign that your claims process is compromised. Denials often occur due to coding errors, inaccurate patient information, or the failure to verify insurance eligibility.
5. Delays in Payments
While a delay in payment might not always signify underpayment, it can indicate a bigger problem. Chronic delays may point to systemic issues with your billing process or insurance carriers undervaluing your claims.
What You Can Do If Your Claims Are Underpaid
1. Audit Your Billing Process
Perform a thorough audit of your medical billing process to identify errors and inefficiencies. Check whether your CPT codes, such as 99396 (Preventive Medicine, Established Patient), are accurate and if you’re submitting the correct ICD-10 codes, like E11.9 (Type 2 Diabetes Mellitus without complications). Billing errors are a common cause of underpayment, so improving accuracy is crucial.
2. Negotiate with Payers
In cases where underpayments are tied to payer contracts, negotiating with insurance companies is essential. Make sure that you’re familiar with the reimbursement rates in your contract and are consistently monitoring them.
3. Outsource to a Professional Medical Billing Service
One of the most effective ways to avoid underpayments and streamline your revenue cycle management is by partnering with a professional medical billing service. This will not only minimize billing errors but will also ensure you’re consistently reimbursed the correct amount for your services.
Streamline Billing Group is here to help. We offer full-service medical billing, focusing on accuracy, efficiency, and maximizing your revenue. Contact us now for the best Medical Billing Services.
The Importance of Using Accurate CPT and ICD Codes
Using the correct Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes is critical in medical billing. Accurate coding not only helps avoid denials but ensures you’re paid fairly for the services you provide. Here are a few examples:
- CPT Code 36415 (Routine Venipuncture): If you’re performing blood draws regularly, ensure you’re using the correct CPT code for venipunctures.
- ICD-10 Code I10 (Essential Hypertension): This is a common diagnosis that, when paired with the correct procedural codes, should lead to timely and accurate reimbursement.
Failure to use these codes properly can result in lower reimbursements or even denied claims, significantly impacting your practice’s bottom line.
Streamline Your Claims with a Reliable Medical Billing Service
Accurate, efficient medical billing is essential for any healthcare provider, and using a reliable service like Streamline Billing Group ensures your practice doesn’t lose money due to underpaid claims. Outsourcing your billing to experts who understand complex payer regulations, coding systems, and reimbursement processes will help you recover lost revenue and focus on patient care.
Testimonial from a Satisfied Customer in Lexington, KY
“Streamline Billing Group has been a game-changer for my medical practice in Lexington. I was dealing with multiple underpaid claims and spending too much time sorting through billing issues. Their team stepped in, audited my billing process, and helped me recover significant revenue. Now, I can focus entirely on my patients without worrying about billing discrepancies. I couldn’t be more satisfied!” — Dr. Amanda Greene, Lexington, KY
Final Thoughts on Identifying Underpaid Claims
Ensuring that your claims are paid correctly is an ongoing process that requires diligence and expertise. By recognizing the red flags of underpayment, using accurate coding, and outsourcing to a reputable billing service like Streamline Billing Group, your practice can ensure that it’s being paid fairly and promptly.
Don’t wait until underpayments stack up and damage your practice’s financial health. Take action now by improving your billing process, auditing your payments, and considering a professional medical billing service. It could save your practice significant revenue in the long run.
Ready to Improve Your Billing?
If you’re tired of dealing with underpaid claims and need a trusted partner to handle your medical billing, contact [Streamline Billing Group](https://streamlinebillinggroup.com/medical-billing-services/). Our team of professionals is here to help you get back the revenue you deserve and streamline your entire billing process.
External Resources:
1. Centers for Medicare & Medicaid Services (CMS): A great resource for staying updated on regulations and billing guidelines.
2. American Medical Association: Learn more about the latest CPT codes and best practices in medical billing.
By optimizing your billing process and staying vigilant about underpayments, you’ll not only protect your revenue but also free up valuable time to focus on what matters most—providing excellent patient care. Streamline Billing Group is your go-to partner for ensuring your claims are paid accurately and on time. Don’t let underpayments hurt your practice. Contact us today for the best medical billing services!