Our payment posting staff understands that even the last penny that the providers deserve to get paid, should not be adjusted as provider adjustment.
Depending on the system capability, staff is trained to review the allowable while posting payments and leave the difference between system allowable and EOB allowable as underpayment recovery balance. The affected encounters are moved to appropriate status to follow up and recover the balance.
Underpayment recovery could be a result of below,
- Incorrect adjudication by insurance – Our underpayment recovery staffs will have the insurance reprocess the claim for the balance amount
- Reduction in Fee schedule – Appropriate document will be forwarded to client for further adjustment.