Any strong medical billing process and medical billing company must compare insurance payments to your contractual allowables and aggressively pursue underpayments. If this is not happening then most likely 5 to 10% of your practice’s revenue is being lost.

Medical billing services have a number of basic steps they should incorporate into their billing process. These steps should include using a claims scrubber, use of no-response calls, posting zero pays, pursuing underpayments, and using likelihood of payment scores for patient collections.

Pursuing underpayments is the focus of today’s article. This pursuit begins first and foremost with comparing the payment information from EOBs to the allowables outlined in the practice’s payer contracts. This comparison must be done in an automated manner and cannot rely upon payment posters catching the underpayments on their own.

Payers have adopted underpayment techniques that are too difficult for a payment poster to spot on their own. Medical billing companies can design their process to battle payers underpayment techniques because they have an advantage over individual practices - they see EOBs for a given payer across multiple practices and multiple states. The enhanced scope allows medical billing companies that pay attention to identify patterns that might be overlooked by individual medical practices.

A disturbing pattern that can regularly be seen by a medical billing company that is paying attention is one where a payer will select a set of procedures and underpay this set of procedures across a large number of providers (often by the same amount). This will continue for about 30 days and then the payer will resume paying the procedures at the correct amount and begin underpaying a whole new selection of procedures.

These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make the underpayments difficult for an individual practice to spot.

Needless to say, it would be difficult for a payment poster to remember enough about the allowed amounts across a practice’s tens of payers and dozens of CPTs to spot the underpayment strategy described above. This is why it is critical that automated comparisons be performed by your medical billing service.

This single action (comparison of payments to allowables) can increase a medical practice’s collections by 5 to 10 percent. This is why you need to insure this critical step is being completed by your medical billing service.

Identifying the underpayments is the first step of the journey. Dogged pursuit of the underpaid amounts is what actually drives up your practice’s revenue. This pursuit needs to go down to even small underpayments because once a payer sees that the small underpayments are being pursued they typically taper off and contractual payments resume at the appropriate level. Much like a small child, the insurance companies are trying to see what the can get away with.

Copyright 2008 by Carl Mays II

Most of the government student loan programs do not require a credit check to be carried out and provide students with significant financial aid. These programs are however need based and usually carry additional criteria that may make it hard to qualify. Even when a student does qualify, the loans only cover a portion of the whole cost of education in many cases. When students are caught in this position then they could look to alternative student loans to make up the shortfall.

However, alternative educational loans also have their pros and cons. A credit check will almost always be required and this is no problem as long as you have a good credit history. The problem is that ‘good’ is very much a relative term and if it is not good enough then you will find yourself paying more than the normal rates of interest.

In addition to the stated rate of interest there are further monetary implications of alternative loans. Fees will normally be added on to nominal loan amounts and a relatively modest loan of $3,000 might easily have 4% in fees added before distribution. That means that $120 of the total loan is not seen by the student but nonetheless must be paid back. As a very rough guide, 3% in fees is equivalent to an additional 1% added to the stated interest rate.

However private alternative loans do have a couple of advantages.

The first and perhaps most obvious one is that funds are available. Private lenders make a profit from the interest and fees which they charge and so have an interest in making money available to borrowers and will work very hard to see that each and every borrower qualifies for a loan. On the other hand Federal lenders adhere to an inflexible set of criteria and there is generally no real appeal if your application is turned down.

Not having to deal with that cold and frequently irrational bureaucracy is another advantage of alternative loans. Private lenders have customer service departments that exist to deal with queries so that customers can get the answers that they need. Government loan programs generally have contacts and help available as well but the answers you get are hit or miss when it comes to quality.

Other practical features that make private alternative loans especially desirable include:

The fact that parents and students do not have to fill out FAFSA (Free Application for Student Aid) forms and provide a mountain of additional documentation. Private loan applications tend to be far simpler and the entire process is easier. But, interest rates and fees could be higher or lower according to the individual loan program.

The best alternative loans have zero fees and rates of interest which are about equal to the prime rate. This is the rate that banks charge one another or their biggest and most favored customers. Getting a rate at prime is a very good deal and getting a rate at 1% below prime is a great deal.

In order to get this sort of loan it is generally necessary for you to have a very good credit history or to apply for the loan with a co-signer who has an excellent credit history.

In the end, the only way to discover whether or not an alternative loan will satisfy your requirements is to go out into the market and take a look at precisely what is available.