James Anderson

Expedited Settlement Offers – The Good, The Bad & The Ugly

You may have seen one before. A seemingly innocuous letter creeps its way into your office, usually via your fax machine. A short letter, commonly from Multiplan or Genex or Prime, that offers you an expedited payment if you accept the fee listed and agree that it is your payment in full. No billing the patient. No further negotiations. Before you accept or dismiss it so quickly you should read the fine print.
            First we should review what these offers actually are. Insurance companies hire repricers to negotiate for them when out-of-network providers submit claims. Instead of losing money by paying the out of network provider’s UCR or applying the full amount to the deductible which could cost the carrier more later on they rely on repricers to tempt providers into accepting lower reimbursement.
            Before accepting or rejecting an offer of expedited payment there are several things that should be evaluated:

  1.       The Fee. When you compare your reimbursement to what your UCR billed fee was is it way off-base? Is there more than a 10% disparity between the two? If so then it may not be in your best interest to accept a much lower offer since you will lose your right to bill the patient the difference.
  2.       Remaining Deductible & Out of Pocket. How much does the patient have remaining? Is the majority of what you are going to collect from the insurance carrier? If this is the case it is another argument against reducing their responsibility. If the patient will bear the brunt of the fee some doctors may consider negotiating out of consideration to their patient.
  3.       Claim Handling. Is your claim a complex one that is likely to take longer than the normal processing time? While repricers offer a promise of payment within 10 days many providers forget that processing times for claims are supposed to be 30 to 45 days maximum.

Using this evaluation formula can lead you to objectively view a repricing offer and make a decision that is good for you, your practice and your patient.


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