I read this GREAT article written by Kathy Mills-Chang about Tracking Insurance Reimbursements and just had to share.
One great way to keep up with what you receive from insurance carriers is to create a tracking form. It may take some time to develop the form, but once it’s complete, and only needs occasional updating, it holds an invaluable amount of information regarding your insurance reimbursements that is useful to your practice. I would suggest using a program such as Excel. Begin with a new spreadsheet and list all of the codes you usually perform in the office in the first columns. Then list all the major carriers you deal with in the columns at the top.
Next, use your managed care fee schedules to fill in allowable amounts from any carriers you have information about. If you don’t know what your allowables are, you should give your Provider Relations representative a call to find out. Each day, use the EOBS received on that day to fill out your spreadsheet. Always complete as many as you can, save the document, and then start again the next day. Within a few weeks, most every code will be completed.
The following are several ideas of how to use the insurance tracking log.
1. Track Contracted Allowable Amounts: We sign managed care contracts for many different reasons. Perhaps this plan, that we belong to covers, a large majority of our patients. Somewhere along the way, however, we lose track of how much they may be paying us. This form is invaluable to record the allowable amounts for carriers with whom we are contracted. With careful review, we may find that certain carriers we are contracted with may be paying a set amount far below that which is acceptable. By revealing this log on a regular basis, we can keep apprised of these numbers.
2. Compare the Amounts with your Cost to Deliver an Adjustment: One of the most valuable numbers that you can know about your practice is the amount that it costs you to do business or patient visit. We determined this amount by taking the total amount of our overhead over a period of time and divide that by the number of office visits in that period. The number that is derived from this calculation will be the amount that it costs you to do business per patient visit. Be aware that you may have certain expenses that go through your business that have nothing to do with delivering patient care. For example, you may have your car payments, as well as your spouse’s car payment paid by your business. Go back through your expenses, and be sure to calculate based on true office expenses when calculating this number. Now, you can compare this number to the allowable amounts from each contracted carrier. If you find that your numbers are not congruent and that you are being paid an amount less than it costs you to see the patient, you may find that you want to make a change. Of course, the more patient to see the lower your cost will be. For example, you may be able to see an extra 50 to 100 patient visits a week without any additional overhead. Of course, this would lower your cost to deliver an adjustment. Be very careful with this number, and eliminate yourself from any plans that don’t pay you a fair compensation.
3. Use the Form to Insure that Carriers Pay Correct Allowable Amounts: Keep this form handy when posting payments to be sure that carriers are paying what they are supposed to pay. By keeping your completed form at the desk when entering payments, you can briefly reference when posting payments to be sure you’re being paid what you should.
This form allows you to be able to track reimbursement from every carrier that you deal with, by the code submitted. It will allow you to note the amounts allowed by each carrier or plan. It is not intended to be used to determine which codes pay the best to game the codes. It’s intended to help you have a better grasp of reimbursement with each carrier you deal with.
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