Allowed amount?

What should be conclusion to be drawn if any payer is allowing 100% of what is billed?

Re: Allowed amount

Could be a few things:

1. Your charge is not high enough
2. They paid it wrong
3. Are you contracted? Maybe they are not taking "contracted" adjustment
4. It's your lucky day (ha ha!)

Research a bit...see what everyone else is paying...(can you run a report) or just check what Medicare allows for a ballpark, and see if your charge amount is too close to that.

Payer allows 100% of billed amount

1. Are you contracted or non-contracted with that payer?
2. If non-contracted, what are plan provisions for patient? Sometimes there is no way to find out this information.
3. If contracted - pull your contract and read it.

My first thought would be that my fee is too low - compare your current standard charge with the Medicare allowable for your region.

Some contracts are written to pay "100% of the XX Ins Co fee schedule, or 60% of billed charge, whichever is lower."

You have to check all of your fees to make certain that, at 60%, they are higher than the allowables for that insurance.