Payment Variance: The Solution

Payment Variance: The Solution

In our three-part blog series, we’ve already covered what payment variance is, how it happens, and how to identify it. If you didn’t already, you probably understand now just how much of a financial drain payment variance can be on your medical business. Read on below to learn how you can address this issue. And be sure to keep a lookout for our upcoming blog on how to negotiate with payers, as well.

To address a particular case of payment variance, your accounts receivable team will need to determine the root cause. Typically there will be some sort of denial code or adjustment reason code attached to a claim that will require your team’s attention in the form of additional documentation, notes, or an authorization.

First Review Your AR

To claim the money that you haven’t received because of payment variance, you’ll need to retroactively review all of your AR in order to decipher, identify, and fix the problems that lead to full or partial claim denials. And because contracts can and do change in regards to particular codes, your team will need to stay on top of new, pertinent information for this AR follow-up.

Make Sure Your System Is Updated With The Latest Contracts

Because your medical business works with multiple payers and many different contracts and fee schedules, there’s a chance that your systems just aren’t updated with the most current and correct contracts. Some payers, including government contracts through Medicare and Medicaid, do quarterly reviews and updates (or perhaps even more often) of codes and billing.

Unless you have ongoing IT support or a team member who is extremely competent in managing and updating your system, this game of catch-up is almost inevitable, especially when some payers:

Include inflators in contracts

Can change terms for certain codes (or unilaterally) with limited notification

Typically, as a provider, you have no control over what the payers are going to decide to pay you for a given service unless you’re a very large provider group. To have some ability to anticipate payment variance, you’ll need to stay up-to-date on any contract changes as they go into effect or – much more preferably – before they do.

Be Forward Thinking

In addition to disputing older claims, your team will also need to take a proactive stance. As soon as payment variance issues register on your team’s radar, they’ll need to identify what needs to occur to prevent that same issue from happening in the future.

By closing the financial gap from older claims, and slowing the drag from the frontend on newer claims, your window of AR will gradually become smaller and more manageable.

Get the Specialized Help You Need to Address Payment Variance

As you’ve likely gathered from our three-part blog series, the only thing more frustrating than losing money to payment variance can be trying to do something about it. Instead of throwing more and more money at the problem by hiring more and more staff members, use artificial intelligence to gain control over payment variance. Allow Beth to:

Handle denials as soon as they come in by automatically re-submitting those claims

Shorten your payment window

Reduce future denials by fixing errors on claims before they go out to payers as you move forward

Even if Beth can’t fix an issue, she’ll at least shorten the window of resubmission and potential payment by tasking one of your team members to examine that particular claim as quickly as possible.

If you want to reduce the money you lose to payment variance, put your trust in Beth and the RCM Brain ninjas. We exclusively focus on making the AR process better. And we keep it affordable: You pay for our services with the money we save you. To book a consultation with us, call 1-855-RCM-BETH or schedule online.

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