Billed charge and related payer allowable

When I negotiate managed care contracts on behalf of clients, one part of the process is to take a practice's top 20 CPT codes and then pull the most recent EOBs from that payer showing these codes. An excel spreadsheet is then created showing the payer's allowable for each of the 20 codes and a comparison to current Medicare rates.

When looking at these EOBs, I still find sometimes (like this week!!) billed charges that are approved 100% for payment by the payer. THIS MEANS THE PRACTICE FEE IS TOO LOW AND THE PRACTICE IS LOSING REVENUE!!! Posters should be instructed that any EOB that comes across their desk where the billed charge is approved for payment in its entirety, that this EOB should immediately be copied and given to the practice administrator for review and a related fee adjustment.

I just wish medical practice's would quick losing money simply as a result of poor internal processes and oversight management.

About the Author

Reed Tinsley CPA

This article is written and reviewed by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.