Leveraging Low-Pay Recovery Efforts to Address Underpayment Issues

From the perspective of providers, payers too often adjudicate claims below the providers’ contracted rate agreements or underpay claims when they don’t have a contracted agreement with the provider. These “low pay” situations, which include denials, can highlight deficiencies in clinical or technical policies, procedures, or processes followed by the organizations. Judgments by payers regarding medical necessity, patient eligibility or authorizations, improper coding, and incomplete patient accounts can all lead to lost revenue for the provider. How should a provider address this opportunity?