Transparency has become a bit of a popular buzzword in recent years. Because of this, it is easy to lose sight of what transparency actually means. This is especially true within the insurance industry and for companies administering automobile no-fault or workers’ compensation claims.
Pricing can be extremely complicated for a variety of reasons. Providers may claim to be transparent with their prices, but is pricing really something that is transparent? It may be more complicated than one might suspect, which is why it is critical for your insurance company to ensure that billing procedures and pricing within all claims are as clear and transparent as possible.
When insurance companies are not clear on provider pricing and billing, it can have damaging consequences in the long term. Some providers for example produce invoices that are extremely unclear. This might occur simply because the Healthcare Common Procedure Coding System (HCPCS) is such a complex system, but it may also be because the provider is overcharging an insurance company on purpose.
On the surface, a provider’s invoice may look fairly straightforward or transparent. However, it is imperative for your insurance company to review all provider invoices to ensure that they are accurate. This can drastically reduce overpayments which, of course, is beneficial to your company in many ways.
However, it can be incredibly time-consuming for adjusters and examiners to review every invoice and take the time to look up the proper HCPCS codes for each and every claim. In fact, this tends to become rather inefficient because of the increased time burden it places upon them.
An experienced third-party administrator (TPA) will be able to take this task away from adjusters and examiners so they can focus on administering claims more efficiently. Northwood is a TPA with over two decades of experience which, will benefit your company greatly.
This extensive experience means that Northwood can step in to review provider invoices and verify that the HCPCS codes used are accurate. Oftentimes, this may mean that Northwood will bundle physician prescribed services together when providers list individual, unbundled codes. This approach saves insurance companies from overpaying providers and helps hold down the cost of claims overall.
Another common source of overpayments to providers centers on the use of not otherwise classified (NOC) codes. Providers may use this code to boost the total invoice sent to insurance companies. Northwood’s review of all invoices ensures that NOC codes are removed and that they are instead replaced with the proper HCPCS codes.
Your company can benefit from ensuring pricing is really transparent. Schedule a call with Rosanne Brugnoni at 586-755-3830 ext. 3771 to discover how Northwood can help hold down claim costs and improve claims efficiency for your company.Leave a reply →