There are many causes behind your payment variances, but typically they are categorised under two categories. The first category happens when payers updates the payment system due to issues such as new schedule for new contract while the second payment variances take place when there are changes in the payment system but this configuration was not that successful.
These situations usually takes place at the beginning of the new contract year. This is the best time to analyze the payment variances to make sure that the situations are under control. Your ultimate goal should be to collect every percent of your payment. Here are few ways through which you can analyze the payment variances:
MODIFIERS
Any add on for specialty surgery is reimbursed at various rates, as it is dependent on the factor whether it is a first procedure or fifth. There are set limitations by Medicare after fifth procedure while other payers don’t do this.
Try to get a detailed with modifier documentation and coding, since this can immensely affect your reimbursement.
UNDERPAYMENTS
Always keep a critical eye on the errors to avoid small underpayments. All the small discrepancy can cost you heavily at the end of the year.
There are numerous reasons for an underpayment and they are chances that they can go unnoticed easily if not kept proper system to check them.
CONTRACT COMPLIANCE
How updated your practice remain with contract compliance policies and fee schedules? You need to remain loaded and updated with the practice management system accurately and currently. Set your priority on how and when the underpayments will be handled. We recommend you to generate a demand letter in case of underpayment and send it to the payor requiring payment as stated by the executed contract.
TIME SENSITIVE
How early can you spot the coding error and resubmit it? How efficient your staff is in getting reimbursed properly and identify the improper payments. Create your practice procedures and policy for contract compliance in mind. With great efficiency, the reimbursement issues can be solved at a faster rate.
The above discussed points can help you in measuring your payment variance. By following these ways, you don’t have to miss a single penny. In order to have a thriving practice, medical practitioners are hiring medical coding and billing company.
