Managed Care Contract Negotiations, Medical Practice Management
Aug 21

Are you finding those payer underpayments?

Did you know that payment accuracy rates among insurance companies have dipped as low as 77 percent according to the American Medical Association's Health Insurance Report Card, a survey published annually by the AMA. The results are, arguably, alarming. It's simply not healthy for your practice's bottom line if nearly one in four insurance payments – or even one in ten – is wrong. Spending a little time now to improve tracking and management of payments pays off down the line.

So do you know what you should get paid? It’s impossible to identify underpayments if you don’t know what you deserve to be paid. Ask all insurance companies with which you participate to provide a current fee schedule. They may balk or delay in providing you with their rates for all 7,000-plus CPT codes, but that’s ok. All you really need is a list of your top 25 CPT codes (including modifiers). Compile the list and request that the payer lists its fees for each one.
However, some payers may ignore your request or drag their feet when asked about payment allowables. The good news is that Medicare reimbursements are publically available; the Centers for Medicare and Medicaid Services (CMS) offer a fast and easy online look-up tool for Medicare. So if your contact is based on a percentage of Medicare, use this site to get an idea of what you should be getting paid. (

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →