Frequent review of payer contracts is an essential part of ensuring providers' reimbursement is accurate and maximized.
Theresa Brandon, managing director at Novia Strategies, shared the following tip with Becker's Hospital Review: "Contracts have become increasingly complex and require close review to ensure payer expectations can be met. Sharing all language changes with key stakeholders provides the organization an opportunity to gauge whether an addendum is 'just semantics' or necessitates a different level of interaction with the payer. Maintaining and systematically updating and sharing a payer matrix provides an excellent quick reference for frontline staff. Including the top 15 to 20 payers will provide frontline staff with the knowledge needed to best support the revenue cycle. To further equip staff with the necessary tools to enhance reimbursement, focus on providing the most critical aspects of the contracts — reimbursement type, special provisions, stop loss/outlier payment, timeframe for notification and appeals."
To learn more about managing payer contracts, access this story from Becker's Hospital Review.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.