Fee schedule analysis and auditing
The insurance allowed amount or the fee schedule is determined by various factors such as insurance plan, provider in-network or out of network status, ACO, PHO, geographic practice cost index, etc. If the practice did not keep up with the ever-changing fee schedule there is a good chance to lose revenue by charging lower than what is allowed.
We constantly analyze each Commercial, Medicare, and Medicaid fee schedules determine the charge amount for the practice management system. We create a custom fee schedule for each practice depending upon their participation. The fee schedule is updated every year depending upon the CMS fee schedule. We review all insurance contracted fee schedules and make changes in the billing system to ensure the maximum possible reimbursement is achieved every month.
We constantly audit if there is a reduction in payments by insurance companies than the agreed contractual amount. If there is a reduction in the allowed amount we appeal against the insurance decision. We will compare the payer contracted fee schedule and the actual paid amount every month and a detailed monthly audit report are Emailed. The difference in the payments is checked and reclaimed with interest to the payers.