When you open Underpayments, you'll see the default view; the view that houses all of the claims you could possibly rework. To get the best results from Underpayments, we've found that the more specific you can get, the easier it is to manage your claims and rework them.
Tips to be more efficient in Underpayments
1. Pick one: underpayments or overpayments.
First thing's first: you need to pick which type of payment you'd like to work. Do you want to be on top of overpayments so you can avoid issues with payers? Or do you want to increase your practice's revenue by appealing underpaid claims?
2. Select a date of service to work from.
You have quite a few options to choose from in this section: select all, last 12 months, last 24 months or custom to drill down to line items that fit your goal.
The custom feature allows you to filter the following ways: "all" allows you to view all dates; "equal" allows you to pinpoint a specific date; "on or after" allows you to drill down to line items on or after a specific date; "on or before" allows you to drill down to line items on or before a specific date; and "between" allows you to drill down to a specific timeframe.
ProTip: Clean up your "detected" list by using "on or before" to gather underpayments that are past timely filing restrictions and move them to "rejected."
3. Determine which payer to spend time on.
Figure out which payer makes the most sense to focus on with the following questions:
Is there a payer you already feel there's an issue with?
Which payer has the highest case mix?
Which payer has the most underpaid lines?
4. Select a fee schedule and drill down to a specific procedure code.
After selecting which payer you'd like to focus on, be sure to select a fee schedule to get even more specific.
Drill down to a procedure code with the most underpaid lines or that you're the most familiar with.
5. Review the information and ask yourself these questions.
Now it's time to uncover why items are considered underpaid and if these items need to be appealed. Look over your reduced list of payments and answer the following questions:
Does this provider need a discount rule added?
Was the code billed with a modifier and a rule needs to be updated or set up based on that?
Is the claim being paid to a different fee schedule? If so is that correct and Rivet needs to be updated or is that incorrect and the payer needs to reprocess?
Is the allowed amount they paid the allowed amount from the prior fee schedule?
Did they take a reduction on a provider when they shouldn't have?
6. Further maximize efficiency with these filters.
Use "modifier" to drill down further and trim the number of line items on your list.
Use "credentials" to see if a group is specifically being underpaid.
Use "provider" to see if a specific provider is being paid incorrectly.
