Provider Level Adjustments (PLB)

Provider Level Adjustments (PLBs) in a Multi-Practice Group Environment

Identifying and Re-Associating PLBs

The following is an excerpt from our client support newsletter called “A Closer Look”, which provides helpful information in dealing with common payment processing, denial/defect and reconciliation issues. This particular article looked into the complexities associated with Provider Level Balance Adjustments (aka PLBs). If you would like to know more about how we can help your physician practice group or MSO, contact us today to arrange for a free consultation. 

What Are Provider Level Adjustments?

Provider Level Adjustments are used to convey adjustment information in 835 files that can increase or decrease healthcare provider payments. It can be confusing to follow and determine what is truly owed for a claim because overpayments are often made by healthcare insurance companies, or interest might have accrued due to late payments. The insurance companies (i.e., payors) will then send correspondence to health professionals requesting a refund for the overpaid claim. They will then either receive a refund to be processed for the overpaid amount, or they will not receive a refund in the time allotted. That balance will then move forward to a future 835 file for overpayment recovery.

Re-Association of Transactions to the Individual Practice Groups

Within a multi-practice group, the process of identifying the particular practice associated with these provider level adjustments becomes exponentially more complex. This is often complicated by the variety and/or lack of information which can be useful to re-associate these transactions to a particular practice.

How does ReMedics Ease this Process?

ReMedics utilizes information provided by the insurance payors, along with any previous payment information collected, to identify the practice for as many of these transactions as possible. For those adjustments that cannot be easily associated to a practice, ReMedics will provide a worklist showing the associated funds so they can be efficiently identified and appropriately transferred.

Multiple Offsetting Adjustments

In some cases, there may be multiple offsetting adjustments across multiple checks as forwarding balances are worked off. It is also possible that items may still be “in progress” from a payor.
While it may require a fair amount of research to tie everything together, some payors may have documentation on how they manage Provider Level Adjustments. If all else fails and a resolution cannot be found, you may need to call the payor to ask for more details to help with the research process.

Working with ReMedics 

By leveraging a single cash management platform, ReMedics manages the data capture, parsing & batch balancing, validation, bank reconciliation & funds transfers for all types of remittance processing. The result is lower operating costs, improved cash flow and increased efficiency. Contact ReMedics to schedule a free Cost Benefit/ROI Analysis.