How do I know if a payer underpaid me?

Every payer signs a contract that says what it will pay for each service. That agreed number is the contracted rate. Sometimes the payer simply pays less than that and sends no reason at all. The claim is not denied. It is just short.

The system compares your contracted rate against what actually landed and flags the difference in exact dollars. If the contract says 150 and the payer sent 110 with nothing left to the patient, then 40 dollars is flagged as a shortfall. You are not chasing a feeling. You are looking at the exact dollars the contract says you are still owed.

One thing to hold onto: money the payer moved to the PATIENT still counts toward the contract. If the payer paid 110 and put 40 on the deductible, the contract is satisfied and nothing is flagged. A shortfall is what neither the payer nor the patient was asked for.

Go to Underpayments in the left menu. At the top is the coverage meter, and it is honest with you: a shortfall can only be flagged where the contracted rate is actually loaded. If only a fifth of your charges have a rate loaded, four in five cannot be checked yet. That is the truth up front, and it is also the argument for loading more contracts. See What is a fee schedule?.

Below the meter, the shortfalls add up by payer. This is the underpaid worklist: forty seven dollars here, forty there. Small alone, real together, and it is exactly the kind of money a month loses quietly. See Where does billing money actually leak?.

You can ask the assistant to total the month for you, so nothing short slips by.