Since your medical business has set prices that you typically stick to for individual services, you would think that your AR department would be able to predict the amount of money you’ll receive from payers. But knowing what payment amounts you can actually expect is more difficult than you might think.

If you want to start making billing more predictable in terms of dollars and cents, download our free eBook 10 Deadly Sins of AR and How to Fix Them. You’ll learn how to better anticipate expected payment amounts and how to address nine other AR sins as well.

The AR team at your medical business knows well the price you charge for particular services, but they can never know for sure how much they’ll actually receive for payment. This causes many issues that hinder the growth of your practice.

On top of frequently receiving well below the dollar amount your medical business should, this unpredictability makes it nearly impossible for your team to know which claims they should rep-submit in order to pursue more money.

And, unfortunately, this issue cannot be solved by focusing on a particular treatment that frequently gets underpaid or even on an individual payer that pays less than many others do.

Currently, your team doesn’t have a feasible way to audit supplied allowed amounts for payers or compare those allowed amounts to the fee schedules and contract terms on file with each individual payer. To make matters worse, particular payers also make frequent changes that affect the expected payment and your team has no way to anticipate these shifts.

Even if your team did closely monitor a particular payer or all of the claims connected to one of the pricier services you provide, they’d still get nowhere fast. By the time your billing office learned anything from this time-consuming work, some payers may have already made changes that alter the expected payment.

Because your team has no other choice at present, they simply have to take payers at their word, leaving all the power in the hands of the companies you’re billing.

Solution: Predict Payment Amounts for Claims

When auditing the EOBs and payments that come in, the majority of medical billing offices are not fully leveraging the fee-scheduling contracts that they have available to them from payers. In fact, over 60% are not auditing their payer EOBs at all.

If the fee schedule and contractual terms are not being managed, a significant amount of revenue leakage can occur through:

  • Structural underpayment where services and codes are being:
    • Bundled
    • Underpaid based on the fee schedule and contractual arrangement that is currently on-file
  • Incidental payment variance caused by the submission of out-of-network claims or other issues

Most practice management systems can work with multiple fee schedules, as well as associated contract terms. Take advantage of these features by taking the time to set them up properly in your system.

Make expected payments less unexpected by downloading our free eBook 10 Deadly Sins of AR and How to Fix Them. To find out how the experts at RCM Brain can help you grow your medical business by improving the way your AR department conducts business, call us at 1-855-RCM-BETH today to book a consultation. You can also schedule one using our online form.

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