I doubt the financing of health care in the United States has much worldwide competition when it comes to complexity. Getting paid is a mixture of knowledge, skill, and sometimes, luck. Sometimes we don’t even know if we have been paid for a given service—and denials can persist for years until some review of “remittance advice” from the payer known as the explanation of benefits (EOBs) reveals the fact. I have found that sorting out payment problems needs an approach just like making a diagnosis of appendicitis in a child with abdominal pain—systematic and with a good working knowledge of the condition. This article is a top-down look at reimbursement that is intended to supply a framework for understanding your practice’s payment shortfalls. Remember that problems can be opportunities—if you fix a problem that is billed in high volume, it is the gift that keeps on giving.

It is true...

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