Unexplained Payment Variances: To Ignore or Appeal?
Medical claim payment variances come in all sizes and shapes. Some payment variance is justified and can be tracked down to modifiers, scheduled contract adjustments or newly-implemented coding guidance. However, some payment variances are more suspect. Some discounts are related to incorrect modifier application and/or usual, customary and reasonable adjustments should be scrutinized for accuracy. The trouble is in knowing what to appeal and what to accept as a correct adjustment. Once a payment variance is identified and the adjustment does not appear to be supported, action should be taken to determine if the payment adjustment is accurate. Here are some steps to consider when assessing payment variances . . . .
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