How are underpayments routed in the system?

• A. To follow-up workqueues
• B. To the payer directly
• C. To the patient
• D. To the accounting department only

Answer: (A)

Underpayments are routed to follow-up workqueues because they require investigation and action by the billing/receivables team. The follow-up queue assigns ownership, tracks what needs to be done, and gathers all necessary information (like the explanation of benefits, payer rules, and patient details) so staff can determine the reason for the shortfall, correct any errors, rebill if needed, or appeal a denial. This structured workflow ensures timely resolution, an audit trail, and clear accountability.

Routing them to the payer directly would bypass internal processes and slow resolution; sending them to the patient isn’t appropriate because it’s typically the payer’s responsibility to pay the allowed amount, not the patient’s. Routing to the accounting department only limits actions to posting and reconciliation without ensuring active follow-up to recover the shortfall.