Author Topic: Need urgent information  (Read 1987 times)

Ango_mark03

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Need urgent information
« on: November 12, 2014, 06:55:13 AM »
Do commercial insurance companies reimburse the claims faster if billed within 24-48 hours from the date of service?
Any survey or a case study?

kristin

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Re: Need urgent information
« Reply #1 on: November 12, 2014, 05:39:33 PM »
To answer the question(if you could just post your questions ONE time, on the appropriate board, that would be great!), each insurance company generally processes clean claims WITHIN 30 days. For some, that means 7 days, or 10, or 14, or 21 days. Just depends on the insurance, and how you send them. There is no special "claim processing rate" because you submit a claim within 24-48 hours.

Case in point, I submit all my claims electronically the same day as the day they happen in my office. And I get paid within 7 days from certain insurance companies, up to 30 days for others, and everything in between.

kristin

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Re: Need urgent information
« Reply #2 on: November 13, 2014, 08:52:32 AM »
Best three in my area are BCBS, Cigna, and Medicare.

DMK

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Re: Need urgent information
« Reply #3 on: November 13, 2014, 10:36:03 AM »
Depends on the area, specialty and the physician's contract.

shanbull

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Re: Need urgent information
« Reply #4 on: November 14, 2014, 09:29:05 AM »
It's not really on a company level where you find the best reimbursement rates, the U.S. health insurance market has gotten so fragmented and complicated that any one company may offer 30 or more different plans with totally different reimbursement rates. Commercial insurance plans pay better than Medicare or Medicaid plans but even within the commercial market the different plans offered by the same insurance company have different reimbursement rates, and some plans pay more for certain specialties and not others. Going by company is too broad/vague to get a good understanding because you would just end up with averages. And even then, the picture of an individual provider's reimbursement rates could be different from an identical provider who signed an identical contract because one provider may see more people with one plan from that insurer than the other does.

RichardP

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Re: Need urgent information
« Reply #5 on: November 14, 2014, 01:45:06 PM »
It would be great if all of you could specify your areas and the best private insurance company there

A biller sends to an insurance carrier a CPT Code (Procedure Code).  Linked to that CPT Code are one or more DX Codes (Diagnosis Codes).

An insurance carrier pays the doctor for that CPT Code.  They sometimes pay different amounts for the same CPT Code, depending on the order in which the DX Codes are linked to it.

The amount an insurance carrier pays for that CPT Code, and any variations based on the order of the linked DX Codes, depends on the contract the carrier has with that doctor.  What those contracts agree to pay for any given CPT Code may vary from one doctor to another within a given region.  But they certainly do vary from one region to the next.

In preparation for the changeover to ICD-10, I combined all the CPT Codes actually used by our clients over the last 12 years.  I sorted that list and deleted duplicates.  There are about 1,600 unique CPT Codes that our clients have billed for over the last 12 years.  About 700 of those are used more frequently than the others.  I could go into our database for each client and ferret out what amount was paid by a given insurance company for each code they paid on.  And I could give you that list.

What good would that list do you?

Unless you have a comparable list from other billers within a given insurance region, and then comparable lists from billers in other regions - my list is only going to tell you what happens in the Beverly Hills area.  And you will rightly say "so what".  You want to compare my list against other lists to get at whatever you are after.

Again - guess what.  None of this is going to happen.  It is too time intensive.  And you won't obtain such lists from the insurance carriers themselves, even tho they have them.  Trade secrets.  They don't want doctors comparing their contracts with each other.

You are looking for something that does not exist - readily-available lists such as I described that you can compare with each other.

You are better off focusing on one specific CPT Code - and see if you can get more than one biller to share with you what one or more of their clients get paid for that code by one or more insurance carriers.  And good luck with that effort also.