Does your Denials Management Software also include an Under/Over Payment Analyzer?
Many facilities do a good job of identifying and re-billing their Denied Charges, but when it comes to identifying “under” payments the process many times is less than perfect.
Are you leaving it up to your biller to identify when a payer has reimbursed at an incorrect rate (per the contract)? This of course will not show up as a Denied Charge, it will show as paid, but paid at an incorrect rate.
Here is a real example: Payer X reimburses $200 for mammography (G0202). When the new contract went into effect Payer X was suppose to increase reimbursement for this procedure by 5%, $10.
For some unknown reason, Payer X actually started reimbursing mammography procedures at $190 per procedure. A small error on the part of a payer is difficult for a facility to identify. The billers would presumably have to have had access to the new contract and taken the time to actually read it.
With BridgestoneHRS’s Denials Management Software and integrated Under/Over Payment Analyzer, management would be notified as soon as the incorrect reimbursement amounts were uploaded into the system. Typically that would be the day the remittance was received.
The same process works for over-payments. Have you ever been notified 3 months into the new contract that a payer determines they have been making over payments to you and decided it is time to take the money back?
With BridgestoneHRS’s Denials Management Software your facility will always know if you are being reimbursed at the correct rate.
For more information contact Wayne Gill at (619) 920-6147 or email at wgill@BridgestoneHRS.com.