As we continue hearing and feeling that the country is in a recession, most practices and businesses are looking for ways to generate additional income and stretch their dollars. But equally important is finding ways to capture revenue that you’re already owed. And with industry estimates showing that up to 20% of a medical group’s claim volume is paid incorrectly,1 making sure your payer contracts and payments are in line is a great place to start.
So what do you need to do? Here are the high points.
- Know which payers are contributing the most to your bottom line
- Understand each payers key contract provisions
- Audit reimbursement amounts to make sure payers are sticking to their end of the deal
Chances are, you don’t have the manpower to dedicate a full time staff member to follow up on all contract details and discrepancies. And while software is available to electronically verify reimbursements, you may not have the money to implement that right off the bat. So start small.
Create an action plan
Don’t just assume that you’re being paid accurately. For every issue you uncover and resolve your practice can see immediate benefits. And if you conduct your audit and see that everything is in line, you can rest easier knowing that you aren’t throwing hard earned money out the window.
Here is a sample action plan to get you started.
- Gather all your existing payer contracts
- Pull payer reports from your practice management or analytics system to find out:
- Which three payers make up the largest amount of reimbursements billed
- For those three payers find which codes make up 80% of your billings
- Also find any expensive procedures being billed to these payers
- Pull the contracts for your three top payers
- Create a spreadsheet to track the details of each payer and the specifics for each code
- Include expiration dates for each contract in the spreadsheet
Then use this information to:
- Verify newly received payments to make sure they match the contract parameters
- Audit past payments to see if receivables were in line with contract terms
- Train staff to watch for new claims where receivables don’t match expected payments
- Have assigned staff member(s) follow up on disputes and underpayments
Don’t let your contracts go unattended
Once you will have all your contract expiration dates noted, create a reminder system. That way you can start preparing to renegotiate each contract ahead of time (knowing which procedures make up the largest part of reimbursements from that payer, being aware of your claim denial rate, etc.)
You don’t want to miss a chance to get an increase on these important procedures. And once those negotiations are complete, make sure you’re receiving your new negotiated rate.
Sage can help
With Sage Intergy and Sage Practice Analytics, all the reports you need to pull are at your fingertips. Easily find which payers and procedures make up the largest segment of your claims without any IT intervention. And beyond payer monitoring, Sage Intergy has built-in tools to aid your practice with claim scrubbing and denial management to help you speed reimbursement times.
Watch an online demonstration of Sage Intergy now or set up on onsite demonstration to see how software from Sage can benefit your practice by:
1 Health Management Technology. (February, 2006). Payer Contracts: The Key to Practice Revenue. Source: http://archive.healthmgttech.com/archives/0206/0206payer_contracts.htm
