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4/19/2012
Medical Billing Made Easy™
Presents
Getting Paid Accurately:
What the National Health
Insurer Report Card Means to
Your Practice and How You
Get Paid
Beginning now…
www.Kareo.com
Today’s Program
Introduction
Presentation:
Frank Cohen
 Kareo Special Offer:
Jason McDonald, Director of Sales, Kareo
 Questions


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How to Participate Today
•
Arrow = Open/close your panel
•
Questions = Submit text questions
Follow-up email with video link
within 24 hours
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1
4/19/2012
Getting Paid Accurately:
What the National Health Insurer
Report Card Means to Your
Practice and How You Get Paid
Frank Cohen
www.frankcohengroup.com
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Contract Value Analysis
“I think the reimbursement speaks for
itself.”
Peter Ragone
Chief Spokesman for San Francisco Mayor Gavin Newsome
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6
2011 American Medical
Association National Health
Insurer Report Card
Payer Accountability
www.ama-assn.org/go/reportcard
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7
2
4/19/2012
Administrative Waste in the
Claims Process
Average cost to physicians: 10-14% of gross
revenue
 The inefficient and unpredictable claims system
adds substantial cost to the health care system,
estimated as much as $
$210 billion annually.
y
 Prior authorization is a big portion of time
physicians and their staff spend on
administrative tasks: 20.7 hrs of staff time a
week
 Physicians spend nearly three full work-weeks a
year interacting with payer on administrative
tasks.

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8
What Data Did We Use?
Physicians’ Electronic Data Interchange (EDI)
files (electronic claims and remittance advices)






Approximately 3.98 million services
Approximately 2.4 million claims
February 1, 2011 – March 31, 2011
42 states
80 specialties
400+ practices
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7 Focus Areas







Payment Timeliness
Cash Flow
Accuracy
Administrative Requirements
Code Edit Sources and Frequency
Denials
Improvement of Claim Cycle Workflow
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4/19/2012
Cash Flow
Metric 2A – Cash flow analysis
120.00%
100.00%
80.00%
60+ days
46-60 days
60.00%
31-45 days
16-30 days
0-15 days
40.00%
20.00%
0.00%
Aetna
Anthem
BCBS
CIGNA
HCSC
Humana
Regence
UHC
Medicare
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11
Cash Flow
Metric 2B – Percentage of claim lines paid = $0
Aetna
24.01%
Anthem
Metric
BCBS
2B - Percentage of claim lines
CIGNA paid HCSC
Humana
$0
25.12%
25.02%
24.05%
Regence
UHC
Medicare
17.25%
24.11%
19.88%
20.21%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Aetna
2011
Aetna
24.01%
Anthem
CIGNA
Anthem
25.12%
HCSC
CIGNA
25.02%
Humana
HCSC
24.05%
Humana
20.21%
Regence
Regence
17.25%
UHC
Medicare
UHC
24.11%
Medicare
19.88%
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12
Accuracy
Metric 5 - Contracted fee schedule match rate
Aetna
Anthem
BCBS
CIGNA
HCSC
Humana
Regence
UHC
Medicare
86.27%
62.08%
86.37%
85.76%
88.51%
86.28%
92.26%
98.91%
100%
50%
0%
Aetna
2008
2009
2010
2011
Aetna
70.78%
82.08%
87.51%
86.27%
Anthem
CIGNA
HCSC
Humana
Regence
UHC
Medicare
Anthem
72.14%
87.94%
77.77%
62.08%
CIGNA
66.23%
83.09%
90.61%
86.37%
HCSC
Humana
84.20%
93.37%
88.63%
88.51%
Regence
UHC
61.55%
74.34%
89.86%
92.26%
Medicare
98.12%
97.53%
98.26%
98.91%
93.88%
85.76%
86.28%
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4/19/2012
Accuracy
Metric 6 – First ERA Accuracy*
Aetna
Anthem
BCBS
CIGNA
HCSC
Humana
Regence
UHC
Medicare
81.08%
61.05%
83.02%
87.04%
81.99%
88.41%
90.23%
96.19%
Metric 6 - ERA Accuracy
100%
50%
0%
Aetna
CIGNA
Aetna
81.23%
81.08%
2010
2011
Anthem
73.98%
61.05%
Humana
CIGNA
84.51%
83.02%
HCSC
87.83%
87.04%
UHC
Humana
82.92%
81.99%
Regence
88.41%
UHC
85.99%
90.23%
Medicare
96.12%
96.19%
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14
Claim Edit Sources and Frequency
Metric 8 – Source of Available Payer Disclosed
Claim Edits
Anthem
CIGNA
HCSC
Humana
Regence
UHC
Medicare
CPT
8.10%
5.10%
11.80%
11.00%
7.40%
14.90%
3.20%
8.90%
ASA
0.10%
Aetna
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NCCI
4.10%
15.40%
7.40%
20.30%
3.60%
1.10%
4.70%
8.80%
CMS
6.30%
48.80%
78.10%
57.10%
32.30%
82.60%
49.40%
36.10%
Payer
81.40%
30.70%
2.70%
11.60%
56.70%
1.40%
42.70%
46.30%
0.00%
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15
Denials
Metric 11 - Percentage of Claim Lines Denied
Aetna
Anthem
CIGNA
HCSC
Humana
Regence
UHC
Medicare
1.38%
3.62%
0.68%
1.59%
2.33%
1.36%
1.05%
2.73%
8%
6%
4%
2%
0%
Aetna
2008
2009
2010
2011
CIGNA
Aetna Anthem CIGNA
6.80% 4.62% 3.44%
1.81% 4.34% 2.56%
2.57% 4.50% 0.67%
1.38% 3.62% 0.68%
Humana
UHC
HCSC Humana Regence UHC Medicare
2.90%
2.68% 6.85%
2.03%
2.02% 4.00%
2.67% 2.18%
2.21% 3.82%
1.59% 2.33% 1.36% 1.05% 2.73%
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4/19/2012
Denials
Metric 14 – Percentage of reason codes (CARC)
reported with a required remark code (RARC)
Aetna
Anthem
BCBS
CIGNA
HCSC
Humana
Regence
UHC
CARC
%
%
%
%
%
%
%
%
16
55.00%
99.79%
0.00%
100.00%
100.00%
41.18%
85.57%
99.77%
96
0.00%
54.55%
95.51%
Medicare
100.00%
99.56%
100.00%
99.42%
125
Unused
100.00%
Unused
Unused
100.00%
0.00%
0.00%
99.80%
129
Unused
0.00%
Unused
Unused
Unused
Unused
Unused
Unused
87.99%
148
Unused
100.00%
Unused
Unused
Unused
Unused
Unused
Unused
226
100.00%
Unused
0.00%
Unused
100.00%
Unused
Unused
100.00%
227
100.00%
100.00%
Unused
100.00%
Unused
50.00%
100.00%
Unused
234
Unused
Unused
Unused
Unused
Unused
Unused
Unused
Unused
A1
100.00%
Unused
Unused
Unused
Unused
Unused
Unused
Unused
D23
Unused
Unused
Unused
Unused
Unused
Unused
Unused
Unused
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17
Analyzing Contract Value
Most practices have several (if not dozens) of
fixed-fee contracts
 Payers are notorious for episodes of improper
payment
 Practices must track EOBs in order to discover
under payments
 Excess capacity practices should ‘triage’
contract benefits

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18
Contract Assessment
Procedure
Code
10040
10060
10061
10080
10081
10120
10121
10140





Current
Contract Contract Contract Contract
Fee Medicare
1
2
3
4
$ 210
84
76
102
118
116
$ 285
93
83
128
141
140
$ 375
168
157
250
274
260
$ 250
160
89
156
168
155
$ 325
250
158
270
312
283
$ 245
129
87
138
150
145
$ 357
242
181
300
330
303
$ 235
130
113
163
188
176
Compare fee to cost amount (line item)
Calculate fee as percent of fee schedule amount
Calculate average payment against allowable
Calculate average A/R days
Dump any ‘bad’ contracts
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6
4/19/2012
Fee Comparisons
Procedure
Code
10040
10060
10061
10080
10081
10120
10121
10140



Current
Fee
% of Fee 1 % of Fee 2 % of Fee 3 % of Fee 4
$
$
$
$
$
$
$
$
210
285
375
250
325
245
357
235
36%
29%
42%
36%
49%
35%
51%
48%
49%
45%
67%
62%
83%
56%
84%
69%
56%
49%
73%
67%
96%
61%
93%
80%
55%
49%
69%
62%
87%
59%
85%
75%
Fee comparisons allow the practice to assess
reasonableness of contract
Line items should be tied into frequency to
determine total contribution to bottom line
Look at relation to fee schedule
 R-Sq = 99.1%
R-Sq(adj) = 97.9%
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20
Distribution of Revenue Impact
Develop a summary analysis of key indicators by
each payer or payer/contract
Payer
AETNA
AMERICAN
BANKERS
BCBS
CIGNA
LINCOLN HERTIAGE
MUTUAL OF OMAHA
NATIONWIDE
PACIFICARE
SELF PAY
STATE FARM
UNITED
Total
% of all
Contract % of Contract % of
Medicare
Collections Collections Fee Schedule
$10,943
3.80%
47.39%
130.62%
3.31%
45.43%
115.16%
$9,550
,
$15,087
5.23%
80.00%
230.19%
19.11%
43.69%
120.40%
$55,088
$9,063
3.14%
43.46%
110.16%
6.48%
80.00%
230.19%
$18,671
4.86%
51.61%
142.24%
$14,018
2.91%
53.33%
135.18%
$8,383
5.06%
43.46%
110.16%
$14,578
$23,716
8.23%
100.00%
287.75%
6.60%
59.64%
164.38%
$19,030
$28,840
10.00%
35.56%
90.13%
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21
Distribution of Resource
Consumption
Include total RVU components to be used for
distribution of resources
Payer
AETNA
AMERICAN
BANKERS
BCBS
CIGNA
LINCOLN HERTIAGE
MUTUAL OF OMAHA
NATIONWIDE
PACIFICARE
SELF PAY
STATE FARM
UNITED
Contract CF Total RVUs
40.98
38 52
38.52
59.85
38.09
36.14
58.03
45.00
45.33
37.66
64.10
52.01
30.38
7,720.60
5 297 82
5,297.82
1,955.45
5,129.78
4,951.80
2,299.20
4,694.40
4,179.76
6,267.84
1,592.80
2,802.00
5,893.80
Work RVUs
Practice
Expense
RVUs
3,269.60
2 578 62
2,578.62
899.50
2,556.40
2,511.84
1,133.58
2,375.19
2,405.52
2,971.76
693.32
1,338.80
2,702.97
4,245.90
2 566 74
2,566.74
991.90
2,408.12
2,278.44
1,090.50
2,164.59
1,652.95
3,125.92
854.04
1,378.45
3,017.31
Malpractice
RVUs
205.10
152.46
152
46
64.05
165.26
161.52
75.12
154.62
121.29
170.16
45.44
84.75
173.52
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22
7
4/19/2012
Reimbursement Validation
Knowing what you got paid and comparing that
to what you should have been paid is a key
step to assessing A/R issues
 Metrics include:







Contract rate to usual charge
All
Allowable
bl tto contract
t
t rate
t
Paid amount to both contract rate and allowable rate
Time from claims submission to remittance
Hassle factor
Open access to claims edit policies
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23
Reimbursement Validation by Payer
Procedure
Code
Period 1 Period 2 Period 3 Period 4
10040
94.3%
97.3%
100.0%
95.0%
10060
100.0%
99.4%
100.0%
95.0%
10061
89.7%
100.0%
94.6%
80.0%
10080
92.6%
100.0%
100.0%
100.0%
10081
88.6%
100.0%
99.4%
100.0%
10120
98.0%
95.7%
100.0%
96.5%
10121
96 4%
96.4%
91 1%
91.1%
95 0%
95.0%
97 5%
97.5%
10140
91.2%
100.0%
96.6%
97.5%


Look for payment ratios less than 100%
Practice should challenge all underpayments
 Reimbursement should be requested on practice’s terms
 Batch repayment

Non-compliance should be reported to appropriate authority
(?) and/or legal counsel
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24
Analyze Payer at Code Level
Cash Fee
Schedule
CPT Code Description
Medicare
Contract
Average
Payment
10021
Fna w/o image
$339.00
$117.68
$129.00
20610
Drain/inject, joint/bursa
$178.00
$63.74
$70.00
31622
Dx bronchoscope/wash
$829.00
$284.53
$313.00
$289.51
36561
Insert tunneled cv cath
$914.00
$1,136.01
$1,250.00
$307.81
36590
Removal tunneled cv cath
$683.00
$244.23
$269.00
$128.96
$59.75
$233.77
43235
Uppr gi endoscopy, diagnosis
$745.00
$259.88
$286.00
$255.80
43239
Upper GI endoscopy, biopsy
$846.00
$297.14
$327.00
$292.40
$318.00
$112.46
$124.00
$100.76
45330
Diagnostic sigmoidoscopy
45378
Diagnostic colonoscopy
$
$974.00
$
$342.03
$
$376.00
$
$338.13
45380
Colonoscopy and biopsy
$1,151.00
$406.25
$447.00
$379.45
45385
Lesion removal colonoscopy
$1,300.00
$459.18
$505.00
$466.16
69210
Remove impacted ear wax
$124.00
$42.99
$47.00
$42.83
91010
Esophagus motility study
$556.00
$186.04
$205.00
$181.24
93503
Insert/place heart catheter
$401.00
$128.46
$141.00
$126.97
99202
Office/outpatient visit, new
$110.00
$58.32
$64.00
$39.04
99203
Office/outpatient visit, new
$164.00
$86.76
$95.00
$55.16
99204
Office/outpatient visit, new
$320.00
$132.77
$146.00
$108.57
99205
Office/outpatient visit, new
$294.00
$167.11
$184.00
$104.14
99211
Office/outpatient visit, est
$37.00
$18.25
$20.00
$12.58
99212
Office/outpatient visit, est
$66.00
$34.15
$38.00
$22.64
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25
8
4/19/2012
Comparing Allowed by Payer
Cash Fee
Schedule
$339.00
$431.00
$336.00
$282.00
$548.00
$201.00
$73.00
$302.00
$440.00
$494.00
$754.00
$200.00
$375.00
$442.00
$865.00
$714.00
$1,377.00
$158.00
$3,866.00
$208.00
$1,010.00
$776.00
$1,024.00
$1,040.00
$1,118.00
$414.00
CPT Code Description
10021
Fna w/o image
10061
Drainage of skin abscess
10140
Drainage of hematoma/fluid
10160
Puncture drainage of lesion
10180
Complex drainage, wound
11100
Biopsy, skin lesion
11101
Biopsy, skin add-on
11400
Exc tr-ext b9+marg 0.5 < cm
11402
Exc tr-ext b9+marg 1.1-2 cm
11403
Exc tr-ext b9+marg 2.1-3 cm
11606
Exc tr-ext mlg+marg > 4 cm
11900
Injection into skin lesions
12021
Closure of split wound
12031
Layer closure of wound(s)
12035
Layer closure of wound(s)
13100
Repair of wound or lesion
14000
Skin tissue rearrangement
15331
Aply acell grft t/a/l add-on
15734
Muscle-skin graft, trunk
16020
Dress/debrid p-thick burn, s
19020
Incision of breast lesion
19101
Biopsy of breast, open
19110
Nipple exploration
19120
Removal of breast lesion
19125
Excision, breast lesion
19126
Excision, addl breast lesion
AARP
$237.00
$302.00
$235.00
$197.00
$384.00
$141.00
$51.00
$211.00
$308.00
$346.00
$528.00
$140.00
$263.00
$309.00
$606.00
$500.00
$964.00
$111.00
$2,706.00
$146.00
$707.00
$543.00
$717.00
$728.00
$783.00
$290.00
AETNA
$141.00
$187.00
$147.00
$123.00
$231.00
$90.00
$32.00
$116.00
$154.00
$178.00
$396.00
$51.00
$160.00
$203.00
$366.00
$305.00
$630.00
$66.00
$1,628.00
$86.00
$427.00
$326.00
$440.00
$460.00
$506.00
$176.00
AMERICAN
$135.00
$179.00
$141.00
$117.00
$221.00
$86.00
$30.00
$111.00
$147.00
$171.00
$379.00
$49.00
$154.00
$195.00
$350.00
$292.00
$604.00
$63.00
$1,561.00
$82.00
$410.00
$313.00
$422.00
$441.00
$485.00
$169.00
BANKERS
$271.00
$345.00
$269.00
$226.00
$438.00
$161.00
$58.00
$242.00
$352.00
$395.00
$603.00
$160.00
$300.00
$354.00
$692.00
$571.00
$1,102.00
$126.00
$3,093.00
$166.00
$808.00
$621.00
$819.00
$832.00
$894.00
$331.00
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26
Calculate Allowable and
Payment Statistics
CPT Code
10021
Description
Contract % of Fee
Fna w/o image
Pmt % of Fee
38.05%
Pmt % of Contract
38.04%
99.97%
20610
Drain/inject, joint/bursa
39.33%
33.57%
85.36%
31622
Dx bronchoscope/wash
37.76%
34.92%
92.50%
36561
Insert tunneled cv cath
38.44%
33.68%
24.62%
36590
Removal tunneled cv cath
39.39%
34.23%
86.90%
43235
43239
Uppr gi endoscopy, diagnosis
38.39%
34.34%
89.44%
Upper GI endoscopy, biopsy
38.65%
34.56%
89.42%
45330
Diagnostic sigmoidoscopy
38 99%
38.99%
31 69%
31.69%
81 26%
81.26%
45378
Diagnostic colonoscopy
38.60%
34.72%
89.93%
45380
Colonoscopy and biopsy
38.84%
32.97%
84.89%
45385
Lesion removal colonoscopy
38.85%
35.86%
92.31%
69210
Remove impacted ear wax
37.90%
34.54%
91.12%
91010
Esophagus motility study
36.87%
32.60%
88.41%
93503
Insert/place heart catheter
35.16%
31.66%
90.05%
99202
Office/outpatient visit, new
58.18%
35.49%
61.00%
99203
Office/outpatient visit, new
57.93%
33.63%
58.06%
99204
Office/outpatient visit, new
45.63%
33.93%
74.36%
99205
Office/outpatient visit, new
62.59%
35.42%
56.60%
99211
Office/outpatient visit, est
54.05%
33.99%
62.88%
99212
Office/outpatient visit, est
57.58%
34.31%
59.59%
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Impact Analysis
CPT
Code
Description
10021
Fna w/o image
1
122.20
0.56%
0.84%
0.04%
20610
Drain/inject, joint/bursa
2
118.73
1.12%
0.81%
0.08%
Frequency
Collection
Frq % for this Collection %
Payer
for this Payer
Frq % total
Collection %
total
0.04%
0.04%
31622
Dx bronchoscope/wash
1
281.76
0.56%
1.93%
0.04%
0.10%
36561
Insert tunneled cv cath
5
1,451.94
2.79%
9.96%
0.20%
0.50%
36590
Removal tunneled cv cath
1
212.57
0.56%
1.46%
0.04%
0.07%
43235
Uppr gi endoscopy, diagnosis
1
248.93
0.56%
1.71%
0.04%
0.09%
Upper GI endoscopy, biopsy
3
789.30
1.68%
5.41%
0.12%
0.27%
45330
Diagnostic sigmoidoscopy
1
96.69
0.56%
0.66%
0.04%
0.03%
45378
Diagnostic colonoscopy
2
669.27
1.12%
4.59%
0.08%
45380
43239
Colonoscopy and biopsy
1
359.63
0.56%
2.47%
0.04%
0.12%
45385
Lesion removal colonoscopy
1
462.61
0.56%
3.17%
0.04%
0.16%
69210
Remove impacted ear wax
2
46.25
1.12%
0.32%
0.08%
0.02%
91010
Esophagus motility study
93503
Insert/place heart catheter
1
119.27
0.56%
0.83%
0.04%
0.04%
99202
Office/outpatient visit, new
2
75.23
1.12%
0.52%
0.08%
0.03%
99203
Office/outpatient visit, new
5
256.92
2.81%
1.78%
0.20%
0.09%
99204
Office/outpatient visit, new
8
775.76
4.49%
5.37%
0.33%
0.27%
99205
Office/outpatient visit, new
9
853.44
5.06%
5.91%
0.37%
0.30%
99211
Office/outpatient visit, est
5
58.81
2.81%
0.41%
0.20%
0.02%
1
169.18
0.56%
1.16%
0.04%
0.23%
0.06%
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Summary Judgment
Category
Fee Schedule
Reimbursement
A/R Days
Contribution

Fee Schedule

Reimbursement

A/R Days

Contribution
Contract Contract Contract Contract
1
2
3
4
40.70%
64.41%
72.01%
67.75%
81.71%
92.44%
97.41%
99.12%
191
69
38
41
6.71%
9.41%
21.77%
17.48%
 1 point for each point above 50% (to a max of 25)
 2.5 points for each point above 90% (to a max of 25)
 Minus 5 point for each 30 day segment to 0
 Minus 5 points for each point above or below 10% to 0
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Calculating Contract Value
Category
Fee Schedule
Reimbursement
A/R Days
Contribution
Total Value


Contract Contract Contract Contract
1
2
3
4
14.41
22.00
18.00
6.10
18.00
23.00
15.00
20.00
20.00
7.00
23.00
16.00
7.00
58.51
76.00
61.00
Not all contracts are good contracts
Self pay/uninsured is becoming more profitable
for medical practices that insured reimbursement
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Dropping a Bad Contract
Can…




Reduce time from
appointment to visit
Improve revenue through
higher reimbursement
patient
without loss of p
visits
Improve patient
satisfaction by reducing
wait time to visit
Reduce stress on staff by
improving collection
process
Payer
AETNA
AMERICAN
BANKERS
BCBS
CIGNA
LINCOLN HERITAGE
MUTUAL OF OMAHA
NATIONWIDE
PACIFICARE
SELF PAY
STATE FARM
UNITED
Total
% of all
Collections Collections
$10,943
3.80%
$9,550
3.31%
$15,087
5.23%
$55 088
$55,088
19 11%
19.11%
$9,063
3.14%
$18,671
6.48%
$14,018
4.86%
$8,383
2.91%
$14,578
5.06%
$23,716
8.23%
$19,030
6.60%
$28,840
10.00%
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Distribution of Uncompensated Care



A value of 1 means the doctor received no payments from his uninsured patient; a value
of 0 means his uninsured patients paid the same as what insured patients would have
paid; and a negative value means the doctor found his uninsured patients more
profitable.
45–59% of physicians actually provide negative uncompensated care; that is, they
collect more, on average, from their uninsured patients than from their insured patients.
12–14% of physicians found their uninsured patients to be more than twice as profitable
as their insured patients
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Patient Perspective






Between 35 and 53% of patients receive some
uncompensated care
26% paid nothing for the care they received
A minority of patients paid less than the typical
insured patient receiving the same procedures
38–52% paid 100% of the professional fee
47–65% of uninsured patients actually paid
more than the average insured patient
8.5–9.6% of uninsured patients paid more
than double what their insured counterparts
paid for the same procedure
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Physician Perspective
Uncompensated care, measured relative to all
insured patients, is −0.07% of patient care
revenues and 0.59% of patient care revenue
using our upper bound estimate
 Relative to the privately insured, uncompensated
care ranges from 0.24% of revenues to 0.8% of
revenues
 Relative to Medicaid, uncompensated care ranges
from −0.75% of revenues to 0.16% of revenues.
 Factor in the cost of doing business with the
payers (crooks) and the compliance risk and the
potential for profitability soars.

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Questions and Considerations

This study used estimated discounting factors
(55%) from 2005

The study does not consider the cost to the
practice of claims processing

Payments for physicians that are now classified
as ‘out of network’ provide some payback to
the patient
 Is it a deeper discount now? YES (48%)
 How much does it cost per claim?
 Does the study underestimate the impact of
shared spending?
More…
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Questions and Considerations
(Cont’d)
What are the compliance implications of
dealing only with cash-paying patients?
 When is the last time you conducted a payer
profitability analysis?

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Developing Your Own Payer
Scorecard

In addition to the above metrics, consider the
following:
 Prompt payment (days from claim submission to
remittance)
 Denials





As % of total claims
Distribution of reason codes
% of reason codes that are incorrect
% of denials reversed on appeal
These can be compared to national healthcare
payer report cards
 i.e., AMA, athenahealth, etc.
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For More Information
Frank Cohen
www.frankcohengroup.com
727.322.4232 (direct line)
g
p
[email protected]
Report Card:
www.ama-assn.org/go/reportcard
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What Next?
Jason McDonald
Director of Sales
Medical Billing Made Easy™
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39
Accuracy
Metric 5 - Contracted fee schedule match rate
Aetna
Anthem
BCBS
CIGNA
HCSC
Humana
Regence
UHC
Medicare
86.27%
62.08%
86.37%
85.76%
88.51%
86.28%
92.26%
98.91%
100%
50%
0%
Aetna
2008
2009
2010
2011
Aetna
70.78%
82.08%
87.51%
86.27%
Anthem
CIGNA
HCSC
Humana
Regence
UHC
Medicare
Anthem
72.14%
87.94%
77.77%
62.08%
CIGNA
66.23%
83.09%
90.61%
86.37%
HCSC
Humana
84.20%
93.37%
88.63%
88.51%
Regence
UHC
61.55%
74.34%
89.86%
92.26%
Medicare
98.12%
97.53%
98.26%
98.91%
93.88%
85.76%
86.28%
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Why Invest Time in
Auditing Payments?
Medical Billing Made Easy™
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$928.50
Single Type of Claim
Medical Billing Made Easy™
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$100,000 Per Month
Medical Billing Made Easy™
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4/19/2012
Simple Steps:
1. Get copies of all your payer fee schedules
2. Begin auditing every payment that comes in against
that contract
3. Appeal ALL under payments
http://www.ama-assn.org/resources/doc/psa/appeal-thatclaim.pdf
Medical Billing Made Easy™
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How Does Kareo Manage This?
1. Free payer-specific fee schedule imports
2. Underpayments are displayed in payment screen
3. Underpayments are displayed in the Contract
Management Summary report
Medical Billing Made Easy™
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Quick Demo
Medical Billing Made Easy™
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