February 2020 Challenge Billing Assumptions

Today’s BIG Ideas podcast is based on a project I am working on for a client back east.  The practice gave me a copy of their fee schedule, downloaded from the practice management system, and asked me to write code to compare the standard fee schedule to what has been billed.  How could the fee schedule in the practice management system be different than what was actually billed?  It turns out there were a bunch of differences, many of which the practice is still working to explain.  What other assumptions might you question in your billing office?  Question the idea that payers always pay consistently for the same procedure for the same plan for the same provider.  Question the idea that all of your adjustments are contractually required or appropriate or consistently made.  One good Pivot Table can put many of these assumptions to rest and show you exactly where to focus your efforts.