BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Payment Variance and Underpayment Services
Payment Variance and Underpayment Services for Patient Financial Services
Maximizing Revenue Accuracy and Safeguarding Financial Integrity
Schedule a Call5%
Underpayment Rate
90%
Average Underpayment Recovery Time
12 Days
Variance Identification Accuracy
Overview
Comprehensive Analysis and Recovery of Payment Discrepancies
Payment Variance and Underpayment Services are designed to identify, analyze, and correct discrepancies between expected reimbursements and actual payments received
Understanding Payment Variance
Payment variance refers to the gap between the reimbursement anticipated based on payer contracts and the actual payment received. This analysis helps pinpoint the causes of discrepancies, such as contractual adjustments and payer-specific factors
Identifying Underpayment
Content – Underpayments occur when reimbursements fall short of the agreed-upon rates. This section focuses on methods to detect underpayments resulting from claim processing errors, misinterpretation of policies, or system limitations
Leveraging Advanced Technologies
Utilizing real-time data analytics, automated claim scrubbing, and integrated EHR systems enables healthcare providers to monitor payment flows effectively. These tools help promptly identify variances and underpayments across all claims
Robust Contract Management
Accurate contract management and regular auditing are key to minimizing payment discrepancies. This involves aligning payer contracts with billing practices, monitoring compliance, and initiating renegotiations when necessary
Financial Impact and Recovery Strategie
Timely detection and resolution of payment discrepancies can significantly improve cash flow. By implementing targeted recovery strategies and dispute resolution processes, organizations can reduce revenue leakage and enhance financial performance
Operations
Streamlined Processes for Managing Payment Variance and Underpayments
A systematic operational framework is essential for addressing payment discrepancies. This framework integrates data collection, automated analysis, dispute management, and continuous performance monitoring to ensure efficient recovery and financial integrity
Data Collection and Integration
Gather comprehensive claim data from billing systems and integrate it with contractual details to establish a baseline for expected reimbursements
Automated Analytics and Alerts
Implement advanced analytics tools to continuously monitor payment data, automatically flag discrepancies, and generate real-time alerts for prompt review
Dispute Management and Resolution
Develop a structured dispute resolution process that includes documenting variances, preparing appeal packets, and directly communicating with payer representatives to resolve issues
Performance Monitoring
Track key performance indicators (KPIs) such as variance percentage, underpayment recovery rate, and resolution turnaround time to assess the effectiveness of financial recovery efforts
Continuous Improvement and Training
Invest in regular training and process reviews to adapt to evolving payer policies and technology advancements, ensuring ongoing efficiency and compliance in managing payment discrepancies
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
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