When healthcare providers receive payments from Managed
Care Plans, the standard procedure for the billing staff is to deposit the checks
without verifying the veracity of the fee
schedules or without analyzing the rejections
and/or denials that appear in the Explanation of Benefits (EOB.)
Providers are UNDERPAID thousands and thousands of dollars from Managed Care Plans and other carriers because the billing staff lacks
the time or the knowledge to scrutinize the payments received.
Twenty years ago only a small number of insurance
companies were paying insurance healthcare claims and physicians were receiving
adequate reimbursement for services rendered. Also the adjudication process twenty
years ago was limited to a few guidelines and rules.
Today hundreds of payers across the nation are adjudicating
claims without the proper software systems to process physicians’ services or perhaps
the claims department pays transactions using a staff that lacks sufficient training
to adequately adjudicate claims.
Researching
UNDERPAYMENTS
We have
found alarming reductions in payments to providers.
Unless you have computerized systems to scrub and adjudicate
claims
the UNDERPAYMENTS remain undetected.
In a forensic analysis
of paid claims at a specialist practice we detected that in the
year 2005
the UNDERPAYMENTS from Managed
Care Plans could exceed $75,000 and that the projected loss from reduction in payments
for the last ten years of the practice could be more than half a million dollars.
We found UNDERPAYMENTS
in MRI and radiology centers, surgical and cardiology practices, pain management
organizations. The UNDERPAYMENTS extend
to most healthcare providers.
Our computerized system
The ADJUDICATOR
has permitted us to report and demonstrate to Managed Care Plans the violations
of Medicare and Standard Adjudications Guidelines.
Payors are now
paying to our clients for their omissions.
For a FREE Consultation please contact us at:
WWW.ACCUCHECKER.COM,
LLC
9460 Fontainebleau Blvd Suite 523
Miami, FL 33172
Phone: (305) 227-2383
E-mail:
sales@accuchecker.com
Website:
www.accuchecker.com