If you make the decision to outsource medical billing, then make sure your medical claims billing company compares your payments to your allowables. It goes without saying that if you do billing in-house the comparison still should be done.

One of the advantages a Medical Insurance Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical claims billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss. One that is seen at large Medical Billing Services on a regular basis is the systematic underpayment of claims by payers. As billing services look across multiple clients they will see the exact same CPTs being underpaid by the same amount by the same payer in a given month across all of their clients. The following month they will see the same payer switch to underpaying a different set of CPTs. These under payments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice.

The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount "under the radar" can make this difficult for an individual practice to spot. It is also difficult for a Medical Insurance Billing Service to spot if they are not comparing your payments to your contracted rates. It has been demonstrated that this single action (comparison of payments to allowables) can increase a medical practice's collections by 5 to 10 percent. This is why you need to insure this critical step is being completed no matter who is doing your Billing.


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