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How to Avoid Losing Money with Health Insurance Claims Repricing

Health Insurance Claims Repricing

Healthcare billing can be a very confusing process. This is especially true if you throw things like health insurance claims repricing into the mix. To not lose a lot of money, it is important to understand how health insurance claims repricing works. Read on to find out more about how you can avoid losing money with health insurance claims repricing.

What is Health Insurance Claims Repricing

This is a simple theory, but it can get a bit confusing in practice. In 2018, 27.5 million people did not have health insurance. Thus, there are a lot of people who might not understand claims repricing. Health insurance claims repricing is the application of contracted payment rates to healthcare billing costs. A health care provider will submit a claim that includes line items for all the services delivered. The payer will then look at the claim and reprice all the items according to the agreed-upon rates. This is known as the allowed amount. So essentially, what happens is that the final amount will be divided between the patient and the plan.

How to Take Control of Claim Repricing Confusion

All payers have different systems for claim repricing. As such, it is crucial for providers to communicate with a representative of the payer to find out about their payment process. This is an effective strategy to avoid losing money.

If you communicate with the payer representative prior to accepting the plan as a mode of payment, you will ensure that your organization receives the correct amount for the health care services rendered. Failure to do so can lead to major losses. You will also spend a lot of time trying to understand remittances and payment methods.

Use Revenue Cycle Management Software

Another great way to avoid losing money as a health care provider is to use revenue cycle management software. These services help organizations to better manage their claims. The software is available for use by home health and home care, among others. It allows health care providers to get paid faster and removes the need to deal with a lot of claims manually.

Insurance claims pricing can be quite confusing. However, the best way to avoid losing money is to communicate with the representative of the payer. This way, you can understand their claims pricing process before committing.