Monitoring payer reimbursement per CPT code.There are many factors to consider when you decide whether to agree to be a provider for a certain payer. It is certainly important to have an adequate supply of patients, but it also is critical to evaluate whether you will be reimbursed fairly for the services you provide. First, you must be paid more than it costs you to provide the service. (1) Second, you must be sure that the payer reimburses you for the full amount designated in the contract. (2) You should analyze an·a·lyze v. 1. To examine methodically by separating into parts and studying their interrelations. 2. To separate a chemical substance into its constituent elements to determine their nature or proportions. 3. all payers' reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. ratios for the CPT CPT See: Carriage Paid To codes that you bill for most often. Your software system should permit you to extract To decompress. WinZip and other decompression utilities use the term to mean "pulling out" the original files from the compressed archive. See WinZip and data compression. charge and reimbursement data to obtain this information. For example, you should have access to a report that lists the percentage of total fees that are reimbursed by various payers for code 31575 (figure). Note that reimbursement for this code varies from 100 to 36%. You should obtain data on other CPT codes for which you frequently bill.
Figure. Reimbursement rates vary greatly.
CPT Code 31575
Base Amount Potential Actual Reimb
Fee Allowed Carrier Name Reimb Reimb Rate-%
403.00 403.00 CORESOURCE 403 403 100%
JF MOLLOY 403 403 100%
INTERNATIONAL ENGINE
CO. 403 403 100%
325.00 CIGNA 403 325 81%
302.00 AETNA 403 302 75%
219.76 MORRIS ASSOCIATES 403 220 55%
NYHART 806 440 55%
ENCORE 806 440 55%
199.50 FORD MOTOR WORKERS
COMPENSATION 403 200 50%
195.00 GREAT WEST 403 195 48%
192.91 KEY BENEFIT 403 193 48%
LOCAL 135 HEALTH &
WELFARE 806 386 48%
UNIFIED GROUP SERVICES 403 193 48%
191.00 AETNA 14,105 6,685 47%
CIGNA 1,209 573 47%
AETNA HMO 806 382 47%
188.70 MEDICAL MUTUAL 806 377 47%
GREAT WEST LIFE &
ANNUITY 403 189 47%
POMCO 403 189 47%
187.94 NALC HEALTH BENEFIT
PLAN 403 188 47%
178.40 ANTHEM 5,239 2,319 44%
BCBS OF KY 403 178 44%
168.92 UNITED HEALTHCARE 403 169 42%
UNITED HEALTHCARE 1,209 507 42%
METRAHEALTH 403 169 42%
153.83 CIGNA 806 308 38%
UNITED HEALTHCARE
SERVICES 806 308 38%
UNITED HEALTHCARE 3,224 1,231 38%
UNITED HEALTHCARE 2,015 769 38%
CIGNA COMPANY 403 154 38%
145.43 CIGNA 403 145 36%
144.95 ELI LILLY EMPL BENE
ADM 403 145 36%
References (1.) Isenberg Isenberg was a County of mediæval Germany. It was a partition of the County of Altena, and was annexed to Limburg-Isenberg in 1242. Counts of Isenberg (1191 - 1242)
(2.) Isenberg SF. Expected payment variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality . Ear Nose Throat J 2002: 81:829. Dr. Isenberg is an otolaryngologist in private practice in Indianapolis Indianapolis (ĭn'dēənă`pəlĭs), city (1990 pop. 731,327), state capital and seat of Marion co., central Ind., on the White River; selected 1820 as the site of the state capital (which was moved there in 1825), inc. 1847. ; sisenberg@good4docs Short for documents or documentation. .com |
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