• Sign in
  •   
  • Talk to Sales
  •   
  • Telehealth
  • Solutions
      • Who We Serve




      • Special Solution




  • Platforms
      • PRODUCT




      • Features ( What We Offer )




  • Resources
    •   Blog
    •   Vozo Support
    •   Webinar
    •   Training Video
  • Company
      • PARTNERS & AFFILIATE




      • Who We Serve
  • Pricing

Get Ready!

We’ll be up and running soon with our new and awesome products. Don’t miss to try Vozo EHR, the all-in-one EHR software for your practice. Sign up now to get early access to our free trial.

payer reimbursement

Analyzing Payer Reimbursements: 4 Best Practices

July 19, 2021 33 Comments RCM
Facebook Twitter Instagram Mail

Do you dedicate resources to analyzing payment accuracy? Lots of practices don’t – and are putting too much faith in payers to reimburse in full on every claim they complete.

Assuming payer accuracy is a recipe for revenue loss. Underpayments are more common than you think, and it’s easy for denials to slip through the cracks when you lack a strategy for analyzing claims at large. If you don’t spot a problem in your reimbursements early on, it may recur unnecessarily – leading to excess losses.

A few extra measures around the office can go a long way to enhancing your revenue performance and stay profitable in the long run. Check out our tips below, or consider partnering with a trusted medical billing service for a more robust (and reliable) approach.

Assess trends by code

Take a look at your practice’s top 10 codes by volume per payer per month for the last six months. Compared to your payer contracts, are the reimbursements accurate? Which payers are deviating from set rates? Are the under- or overpayments happening consistently, or sporadically? Is a certain provider in your office affected more frequently than another?

Ideally, you won’t find any of these issues. But when you look at six months of data, any payment gaps should show themselves quickly. If you spot them, you’re wise to invest in using contract management software to identify these trends automatically and provide analytics on performance over time.

Investigate the gaps

Armed with insights into where over- or underpayments are taking place, you can take steps to resolve the problems. Start by looking for the source: Are you making mistakes internally – say, by leaving off modifiers (or other coding mistakes)? Or are payers going rogue despite your own office’s accuracy?

This issue is especially important to investigate every January. A common reason for inaccurate reimbursement is fee schedule misalignment: Practices often lose a lot of money early in the year, when payers have yet to update their systems with new codes and updated relative value units (RVUs).

Address every issue

Whether a problem stems from poor coding, payer miscoordination, or both, your analysis gives you the power to proactively resolve it. (And with a closer eye on your contracts, you can spot every inaccurate payment as soon as it happens.)

Invest in scrubbing claims prior to submittal to ensure you’ve coded them properly. Keep the lines of communication open with your payer contacts to make sure contractual rates are paid. And in the instance of any underpayment – your fault, or the payer’s – follow up, fix the claim, resubmit, and get every dollar you’re owed. Because unless you’re applying resources to reimbursement accuracy, you put your profitability at risk.

Find Resolution for Major Claim Denials

Some practice management vendors offer robust billing analytics to help practices understand the root of the denials, but some practices may need to do this manually by analyzing the claim adjustment reason code (CARC) and remittance advice remark code (RARC) that are included in each transaction. Payers—particularly local Medicaid and Medicaid managed plans—may also use their own non-official reason codes.

When these codes aren’t readily available on the payer’s website, practices should call them to obtain the list. If you really narrow it down to your practice and what you do, you can learn your payer codes pretty easily.

Whether you need help with payer reimbursement or your entire RCM process, Vozo billing experts are available 24/7 to help you to improve your practice workflow by providing the best revenue cycle management solutions.

  • Popular
  • Healthcare guide to paperless patient onboarding A Perfect Healthcare Guide To Paperless Patient Onboarding 5 views
  • Intelligent Patient Portal: An Innovative and Patient-Centric Healthcare Technology Intelligent Patient Portal: An Innovative and Patient-Centric Healthcare Technology 3 views
  • EHR Software Cost: How To Set Your Budget In 2022? 3 views
  • A Smart Guide To Electronic Superbills In 2022 3 views
  • Stratified Psychiatry: Unlocking Precision Psychiatry with Electronic Health Records (EHR) Stratified Psychiatry: Unlocking Precision Psychiatry with EHR 3 views
  • appointment scheduling What Makes Online Appointment Scheduling So Popular Among Healthcare Practices? 2 views
  • LLM-based Patient Portal: Why Hospitals Hesitate and How Taboos Can Be Broken LLM-based Patient Portal: Why Hospitals Hesitate & How to Break Taboos 2 views
  • patient charts Patient Charts: Everything You Need To Know 2 views
  • Nutrition Screening in EHR: How it Improves the Chances of Better Health Outcomes 2 views
  • EHR & FHIR EHR and FHIR: 5 Challenges & Solutions in Managing Acute Diseases 2 views

Tags

RCM

Call us : (571) 213-3245

Email us :  info@vozo.xyz

Facebook Twitter Youtube Linkedin

Who we serve

  • Provider
  • Patient
  • Government
  • Not For Profit
  • Research & Academics

What we serve

  • Telemedicine
  • Chronic Care Management
  • Medical library
  • Interoperability
  • Remote Patient Monitoring

Platforms

  • Electronic Health Records
  • Practice management
  • Revenue Cycle Management
  • Patient Portal
  • Medical Biling

Features

  • Integrated labs
  • E-Prescribing
  • Patient group
  • Quick Onboarding
  • Advanced dashboards

Resources

  • Blog Space
  • Vozo Support
  • Webinar
  • Training Video

Company

  • About Us

Patners & Affiliate

  • Become a Partner
  • Affiliate Program
  • Refer a Colleague
  • API Developer

Pricing

Call us : (571) 213-3245

Email us :  info@vozo.xyz

                    
Who we serve
  • Provider
  • Patient
  • Government
  • Not for profit
  • Research & Academics
What we serve
  • Chronic Care Management
  • Medical library
  • Interoperability
Platforms
  • Electronic Health Records
  • Practice management
  • Revenue Cycle Management
  • Patient Portal
  • Medical Biling
Features
  • Integrated labs
  • E-Prescribing
  • Patient group
  • Quick Onboarding
  • Advanced dashboards
Resources
  • Blog space
  • Vozo Support
  • Webinar
  • Training Video
Company
  • About Us
Partners & Affiliate
  • Become a Parner
  • Affiliate Program
  • Refer a Colleague
  • API Developer
Pricing
© Copyright 2023. All Rights Reserved
  • logo-dark-vozo
  • logo-dark-vozo
  • logo-dark-vozo
  • logo-dark-vozo