The automated billing and reimbursement systems used by hospitals and health insurance companies are generally accurate. However, some insurance claims will inevitably be underpaid. This can happen even when all of the procedures have been coded correctly. For a hospital, even small discrepancies in payment can add up to millions of dollars in lost revenue over the course of a year. It's important for hospitals to recover this revenue by filing appeals for underpaid claims.
However, one of the challenges of filing appeals for claims is identifying them in the first place. This is where healthcare underpayment revenue recovery solutions come in — they allow hospitals to quickly realize when they've been underpaid for a claim that they have submitted to a health insurance company. These services almost always pay for themselves in terms of the revenue that's recaptured, so it's worth it for hospitals to implement them. To find out what your hospital should look for in an effective healthcare underpayment revenue recovery solution, read on.
1. Creates an Accurate Expected Reimbursement Calculator
The first step in identifying underpayment from health insurance companies is creating an accurate calculator for the expected reimbursement amount. This calculator is based on the contracts that your hospital has formed with each health insurance company that acts as a payer.
Most discrepancies in insurance reimbursement arise because the contracts are complex and the language can sometimes be vague. When a provider and the insurance company interpret the contract in different ways, variances in expected payments will naturally arise, and these will almost always result in underpayments in favor of the health insurance company.
When your healthcare underpayment revenue recovery platform has an accurate reimbursement calculator, you won't miss any underpayments. As soon as a reimbursement arrives at accounts receivable, you'll be able to immediately compare the payment amount to the calculated amount. This allows your collections team to take immediate action on any underpayments.
2. Identifies Which Claims Are Worth Appealing
When you file an appeal on an underpaid health insurance claim, it's your responsibility to show the insurance company why your interpretation of the insurance contract is the correct one. This often requires a significant amount of manual intervention on the part of your hospital's collection team, which means that not all underpaid claims are worth appealing — your collections team doesn't need to get bogged down dealing with low-value underpayments.
An excellent healthcare underpayment revenue recovery solution will allow you to easily identify which claims are worth sending to your collections team for an appeal. Additionally, it should also be able to identify groupings of claims that all share the same errors. All of these claims can be appealed at once with the same argument, which is a very efficient use of your collections team's time.
3. Provides Staff Training and Support to Reduce Frequent Billing Errors
When your healthcare underpayment revenue recovery solution categorizes groupings of errors, it also allows you to train your coding staff to avoid them. Coding mistakes are a common way to receive less pay for procedures than you're owed according to your contract with a health insurance company. By avoiding errors up-front, your collections team won't have as many appeals to make for underpaid claims. Additionally, you'll also make your revenue stream more reliable by avoiding the need for a lengthy appeals process.
4. Implements New Regulations and Insurance Contracts Immediately
Finally, any new regulations from the government or changes in the contracts that you have with health insurance companies need to be integrated into the system on the date that they become effective. In order to do this, your healthcare underpayment revenue recovery solution needs to implement and test these changes into the expected payment calculator weeks before they go into effect. When this is done, your hospital will have a better idea of upcoming changes in revenue along with making sure you'll be able to accurately audit insurance claims under the new rules.
Overall, an effective healthcare underpayment revenue recovery solution needs to maximize accuracy while also reducing the need for your collections team to file manual appeals. By training staff and going after high-value claims, your collections team will work more efficiently and generate more revenue for your hospital. If your hospital has a persistent problem with underpayment from insurers or doesn't know when underpayment is occurring, work with a healthcare underpayment revenue recovery provider to improve your ability to detect and appeal underpaid claims.Share