Billed versus paid
Billed versus paid is the gap between what a provider charged and what was actually accepted. It matters because states differ on which number a jury is allowed to hear.
A provider bills $84,000. Insurance pays $19,000 and the balance is written off. The question of which number the jury hears is worth more than most liability arguments in the same case.
Jurisdictions answer it differently, and the answer changes with the payer — private insurance, a letter of protection, Medicare and Medicaid do not behave alike.
Why it is a records problem
Both figures are in the file, spread across billing ledgers, explanations of benefit and adjustment entries that do not announce what they are. Reconciling them by hand across several providers is tedious and error-prone, and errors here go straight into the demand.
A firm that cannot state its billed and paid figures quickly is a firm that will either under-demand or have to correct itself, and the second is worse.
Not ready to book a call
Send us five pages of a record set. We will send back what we found in it.
Five pages is enough, redacted however you like. You get a short video back within two business days showing what a chronology would surface from it: the dates, the gaps, the things worth knowing before the other side finds them.
- Send five pages of a real file. Redact whatever you like first.
- We run them and record what comes out, including what it misses.
- You get the video within two business days. If there is nothing worth showing, we say so.