We have been monitoring our payments with specific carriers in which we have negotiated fees established. We have noticed numerous underpayments due to the fact that the negotiated cpt has a lesser RVU than the incidental CPT. For example, our primary CPT is 43775 (RVU not assigned by CMS yet, but it is around 36) We have a negotiated fee of $4000. The incidental cpt we often do at the same time but not always planned is 43281 (RVU 45). The carriers are underpaying our negotiated CPT as secondary procedure due to the lesser RVU. The 43775 (Sleeve Gastrectomy) is actually our primary procedure, (43281) Hernia Repair is secondary.
I'm trying to find a way to avoid the underpayments from occuring on initial submission. Listing 43775 does not work, we have thought about sending 2 separate claims.
Even though common procedure is to pay the higher RVU code primary on the insurance end. Shouldn't they be required to pay the negotiated lesser RVU code first and recognize that during adjudication?
Any thoughts?
Thank you,
Gina
I'm trying to find a way to avoid the underpayments from occuring on initial submission. Listing 43775 does not work, we have thought about sending 2 separate claims.
Even though common procedure is to pay the higher RVU code primary on the insurance end. Shouldn't they be required to pay the negotiated lesser RVU code first and recognize that during adjudication?
Any thoughts?
Thank you,
Gina