RCM tip of the day: Audit for underpayments

Healthcare organizations have various methods at their disposal to help identify and fix underpayments from payers, according to Leonard Wenyon, vice president of solutions at New York City-based IKS Health.

Mr. Wenyon shared the following tip with Becker's Hospital Review.

"In an era of smaller reimbursements and higher cost of care, time spent auditing for underpayments is well worth the investment. Underpayments may often go unnoticed or seem too time consuming or costly to pursue; however, there are solutions to make the process painless and profitable. Use a practice management system to store contracted health plan fee schedules. These systems can be programmed to automatically flag underpayments. When discrepancies are identified, deny payments and reach out to the payers to rectify reimbursements. If your practice doesn't employ a practice management system, you can manually look up payments. Medicare and Medicaid reimbursements are publically available; CMS offers an online look-up tool

"With shrinking reimbursements, using integrated platforms can provide detailed actionable data to ensure your payments are correct. Along with proper coding, clinical documentation and patient services rendered, tracking payments from payers gives detailed insight into reimbursement methodologies that can help independent groups, hospitals and health systems improve their bottom line."

Read more about Medicare reimbursement here.

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.

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