Time to insurance reimbursement homeostasis

[acleverpsychpun]

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I am fresh out of residency and have been working at a private practice where I keep a percent of my billing for the last 4 months. So far my reimbursement has been way below what I had expected. Am I being impatient in thinking at this point my reimbursement should be roughly equal to my billing? I’d heard it typically takes 3 months for insurance to pay, does that seem accurate?

 

[splik]

It depends on the insurance company, what codes you are billing, whether there are any errors with billing, whether billing is done electronically etc. Quickest is about 3-4 weeks. I have some bills from earlier 5 months ago that have not been paid. also patients may be slow at paying co-pays and co-insurance

 

[finalpsychyear]

I learned coding myself so here is the first thing to understand. Billed amount and allowed amounts are 2 different things. Since various insurers reimburse in a range of payments the billed amount is 2-3x higher than the allowed charges and the difference is written off.

Example: allowed amount for 99213 is typically 60-100 depending on various insurers but the billed amount is always 200 for example. Even if you bill the insurer who pays you 60 the difference is written off and the patient is not responsible unless you are out of network for that insurer. So if you billed 5 of these your billed amount would be 1000 but the actual allowable amount would be anywhere from 300-500 depending on the insurers. Then to further complicate matters some of the allowable amounts could be the patients responsibility ex: 20 copay etc. This is assuming you have 100% collections.

 

[Sushirolls]

I think my fastest turn around on a submitted insurance bill was like 10 calendar days. That same company has also taken like 8 weeks for other bills submitted. Medicare is by far my slowest overall. I just recently got some resolution on a handful from a different company that were like 6 months old. I've got one company that hasn't even paid anything yet after 4-5 months, because they wanted records and even now things are "still in review."

As finalpsychyear pointed out, a bill submitted for $200, might get reduced down to $100, of which the insurance pays $60, $20 was the co-pay (supposed to be at time of service) and even an additional "co-insurance" of 20% which is the residual $20 needed to be collected from the patient.

-Some patients have an insurance that pays the entire reduced amount
-Some only have a co-pay
-some only have a co-insurance percentage
-some have a co-insurance and co-pay
-Of course there is also the deductible, with it now being January, many patients are paying a larger component out of pocket. Which means potentially harder to collect... which gets at what fianlpsychyear alluded to on *if* you have 100% collections...

-Then there is your unique detail... you are only getting a Percentage of collections. So of the exampled $100 above, you are only getting, 40%? 70%? 60%? etc. of what was actually collected.

Now you should start to see why you are getting paid below what you expected and why its taking so long.