UNDERPAID CLAIMS

Medical billing can be a complex and time-consuming process, especially when it comes to dealing with underpaid claims. However, a skilled medical biller can utilize industry knowledge and personal connections to get underpaid claims paid at the correct level, according to FAIRHEALTH.

FAIRHEALTH is a non-profit organization that provides independent, unbiased data on healthcare costs and medical claims. It is often used as a reference point by insurance companies and medical providers to determine appropriate payment levels for medical services.

Here are some ways in which a medical biller can use industry knowledge and personal connections to get underpaid claims paid at the correct level:

1. Familiarity with industry standards: A skilled medical biller will have a thorough understanding of industry standards and guidelines, including those set by FAIRHEALTH. They can use this knowledge to identify underpaid claims and advocate for fair payment levels.
2. Building relationships with payers: Developing strong relationships with insurance company representatives can be highly beneficial when it comes to resolving underpaid claims. By building personal connections and understanding the specific requirements and processes of each payer, a medical biller can expedite the resolution of underpaid claims.
3. Providing additional documentation: In some cases, an underpaid claim may be due to a lack of sufficient documentation or clarification. A medical biller can provide additional documentation, such as medical records or detailed descriptions of services provided, to support the claim and demonstrate its accuracy.
4. Appealing the decision: If a claim is still underpaid after initial attempts to resolve it, a medical biller can appeal the decision. This may involve providing additional documentation or engaging in negotiations with the payer to demonstrate the value of the services provided.

Conclusion:

Overall, getting underpaid claims paid at the correct level according to FAIRHEALTH requires a combination of industry knowledge, personal connections, and persistence. By understanding industry standards, building relationships with payers, providing additional documentation, and appealing decisions when necessary, a skilled medical biller can ensure fair payment for medical services and help healthcare providers maintain their financial stability. At Stratagem Recovery Solutions, we have a team of experienced medical billers who can help you get your underpaid claims paid at the correct level. Contact us today at www.stratagemrs.com or call us at 302-932-5726 to learn more about our services.