The Underpayment Challenge Capturing Dollars through an Organized Approach to Payment Compliance

Practices have struggled mightily to ensure payment compliance with managed care organizations (MCOs). In good faith, practices have signed contracts offering discounts and in return have expected timely and accurate payment as well as delivery of enrolled members. Unfortunately, many payors enjoy an additional de facto discount via underpayments and inappropriately denied or rejected claims. Whether the cause behind the inaccurate payment is by design, due to a conflicting contractual interpretation, or the result of the payor’s system being unable to handle a complex contract, the practice needs to be able to identify and challenge any payments it deems to be at variance to its interpretation of the contract.