Under Paid Claims Audit
Some claims might be settled for a sum lesser than the sum billed. It might happen due to contractual errors, billing errors, and any miscommunication between the insurance company and the practitioner. Claim denials are entirely different from underpaid claims. Here are a few common causes of underpaid claims:
Contractual Errors on the Payer’s Side
Generally, the claims are paid as per the contracts between the practitioners and the payers. Sometimes there might be a few clauses that are unclear or open to interpretation. There might a ‘lesser of’ clause hidden in the contract, which is often misinterpreted. These clauses should be clarified during the negotiation.
Coding and Documentation Errors on Provider’s Side
Sometimes the errors in the coding and documentation might stop the payers from making 100% payment even though they want to. Such documentation errors lead to underpayments mostly when compared with denials. To overcome this problem, Medleeds puts its best staff into action for fixing any documentation error.
Strategies for Avoiding Underpaid Claims
Medleeds experts plan and arrive at a perfect strategy to avoid the rate of underpaid claims:
- Up-to-Date Coding and Documentation – Keeping the documents updated and readily available for submitting claims
- Effective Denial Management – Run thorough audits to reduce the claim denial rate
- Strong Contract Negotiation Skills – Read every word of the contract and ensure there is no hidden or misinterpreted clause.
