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Underpayments happen every day! In an environment where every penny counts, a single underpayment and systemic underpayments just can’t be overlooked. Every payer has their own rules. And payer software that can be riddled with flaws, often underpaying claims for years.
Contract Payment Manager (CPM) is the only tool you will need to quickly verify payments against contracted rates and nearly every type of payment rule. CPM is not a one size fits all tool. It is customized to apply payer reimbursement guidelines for each individual practice using multiple criteria. The site of service, type of provider, modifiers, multiple procedure reductions, bilateral billing guidelines, payer reimbursement guidelines, sequestration, and more are all considered when looking at each line item on a claim.
Managers and staff can view a dashboard summary of open underpayment exceptions, and use a dataset that can be sorted by payer, provider, location, etc. to view the day’s open exceptions. They can also review all of the underpayments, whether they need to be appealed, have been appealed, resolved or need even a second appeal. Appeal tracking with filters by staff, payer, modifier and timely filing deadlines can easily be viewed to help prioritize work.
Using CPM data can provide data for payer negotiations and resolve hundreds of underpaid claims at once. And CPM can extract the exact allowed amount for preparing patient estimates. Management can also review staff productivity as well as appeal success rates by staff member, payer and by CPT. This tool is very easy to use, and puts much of the control at the practice level. Contracted allowed amounts are easily uploaded using Excel spreadsheets and accessible (downloadable) with the Code Look-Up Tool.
Every dollar counts. What are you waiting for?