Revenue Cycle Management Blog | GroupOne Health Source

Complete Survey: Help End the Underpayment of Med Insurance Claims

Written by Kaitlyn Houseman | May 8, 2012

Are your claims underpaid by private payers?  Do you have any way of checking the accuracy? 

According to the 2011 AMA Health Insurer Report Card, 1 in 5 claims are processed incorrectly.  In addition to measuring overall claims processing accuracy, the report card examined how accurately insurers reported the correct contract fees to physicians. Contracted fees were correctly reported 62.08% on low side (Anthem BCBS) to 98.91% on high side (Medicare).  For more information, read this.   

As a general rule, contracting law would require that a payer, under contract with a practice, make available the fee schedule being used to pay for services provided to the payer’s subscribers. Unfortunately, this is not a statutory requirement in all states, the logic of which eludes us. However, if providers cannot access the contracted fee schedules, the practice cannot use the fee schedule to ensure they are getting paid what they are supposed to under the agreement. This practice is inherently one-sided and provides for unfortunate business partnership for the practice.

Often, it may be very difficult to downright impossible to obtain contracted fee schedules from most private payers.  Frank Cohen, with the Frank Cohen Group, has designed a survey to test and quantify this assertion. In the survey, he has listed the top 10+ payers.  In order for the results to be significant when stratified by payer, he needs a large number of responses. He intends to use the results of this survey to press states to enact laws requiring payers to make fee schedules available to participating providers, in a user-friendly format.

If you are interested in helping address the problem, please take a few minutes to take the survey here.

The results will be made available at no charge upon completion and analysis. The survey closes on May 18th, 2012.  Also, please feel free to distribute this to other individuals, groups, associations, lists, etc.  Hopefully we can help make a difference.