If your computerized billing system doesn’t permit automatic comparison of what you’re paid to what you’re supposed to be paid by each third-party payor, it’s probably time to upgrade. The extra income you collect by pursuing exceptions may outweigh the cost of an upgrade—or even of a new system altogether.
Your system should allow you to input the amount each payor plan undertakes to pay for each procedure you perform. And if you work under several contracts with the same payor, you should have it spelled out by contract, not just by company.
You may know the figure because it’s specified on a discounted fee-for-service basis in your contract. Or it may be on the Medicare Resource Based Relative Value Scale, in which case you’ll learn the expected payment as you receive explanation of benefits forms.