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A Plan of Attack on Getting What You Owe from Payers : Page 2 of 2

A Plan of Attack on Getting What You Owe from Payers : Page 2 of 2

Data driven decisions

When you know what is being denied by whom and on what basis, patterns emerge. Individual claims that might not be worth pursuing may appear to be part of a larger pattern worth addressing. Here is an outline of the advantages to tracking this data:

• You can see what you have left on the table, and with whom

       • Allows you to see if one insurer is underpaying you vs others

       • Allows you to see if one insurer is underpaying you vs itself

• You can determine how to allocate tasks

        • Administrators:

            • Gathering correct insurance information

            • Tracking response due dates and responses from companies and plans

         • Physicians

             • Coding

             • Claim documentation

         • Attorneys

             • Data gathering management; supervision of administrators

              • Claim grouping management with physicians for letters and action

• The world is becoming more data-driven. As is becoming clear from Medicare reimbursement protocols, physicians are increasingly being compared to each other – being graded on the curve. While the days of being paid fair value for your services are long gone, the situation is only going to get worse.

• What do to? Use the data you are being required to use for Medicare to help you obtain reimbursement from commercial payers! Develop a robust database that explains who is paying you what for a given service and use that data to negotiate effectively with others. Data is objective. It speaks, where requests and simple demands don't.

You can do this!

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