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Providing free resources and useful informations for Physicians,
Office Managers, Medical Billers and Medical Coders
Insurance Payment paid 100% of Charged Amount.
hmmm!.. strange!


Honestly, if I see EOB like this, I will be very very nervous! I could have been paid more
than what I have charged.

TrailBlazer (State of Texas) could have allowed $170.40 for CPT 99244, how much did
you lose on this claim? --- $80.40!

New York Part B allows $164.8, how much did you lose? ---- $70.80.

Now, here's the deal! --- if you get paid at 100% based on your charged amount you
should find out about your fee schedule or contracted rate. Make sure you know you are
not undercharging the insurance company.

But if you did undercharge the insurance company and wants that money back, ofcourse
by all means, you can recover that money! Based on my experience, you can go back as
far as 3 years from the date the claims were paid. I haven't tried more than 3 years of
claim to recover due to undercharges! Afterall, when the insurance company overpays
you and discovers the overpayment, they can always go back as far as more than 3
years I think. Or depending on where state you are located.

Pay attention on your EOBs! I think that's the key. As soon as you discover there is an
undercharging and you were paid 100% on your charged amount. Pick up the phone
and call that insurance company!