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Healthcare payer contracts are complex legal agreements that, if not properly handled and overseen, can cause significant difficulties for healthcare providers. Among many other things, they specify how healthcare organizations are paid for providing treatments to insured patients – this takes into account everything from medical necessity to provider credentialing to provider networks to standard payment rates.
It’s common for healthcare providers to miss deadlines for filing claims or fail to satisfy requirements for timely compensation. This is often because of the difficulties in adhering to these intricate agreements and learning all the terms and nuances. This may lead to providers not getting all the reimbursements they’re owed, which ultimately takes a high toll on the revenue cycle.
Healthcare organizations often have many different administrative tasks to manage, and payer contracts can stretch already limited resources. Still, it’s essential to understand complex payer contracts and learn more about payer contract management. Here are five of the top tips for healthcare providers from PayrHealth, a healthcare payer contracting expert with combined decades of industry experience.
1. Keep Track of Payor Contracts Using Contract Management Software
With contract lifecycle management software, healthcare providers can store all payor contracts centrally, saving them the trouble of constantly rummaging through shared files for a particular contract whenever needed. Shared spreadsheets can become prone to error and get lost in your system. This type of software can keep everything centrally located and easily accessible. If you haven’t already, consider implementing contract management software that allows you to share insights with your payor contractor for additional support.
2. Pay Close Attention to Contract Language
Anyone who oversees payor contracts should have a firm understanding of the wording of these agreements to recognize standard requirements and problematic terms. Examining your payor contracts more closely can show you whether they include provisions on reimbursement guidelines, network requirements, and unilateral amendment language—that is, the ability of payer organizations to alter agreements or change contract provisions without the provider’s approval.
3. Examine Key Clauses and Information
To manage payor contracts effectively, you’ll need visibility and understanding of every clause in your agreements. That includes, of course, the different reimbursement rates, fee schedule, and guidelines. It also includes how long a provider has to file a claim after rendering a service, how long the payor has to pay the provider back, and what conditions must be met to terminate or renegotiate a contract.
With contract management software like that mentioned above, you can run reports to examine how this information differs across all contracts in your portfolio, allowing you to make data-driven decisions about revenue cycle management.
4. Set Calendar Alerts for Dates of Termination and Renegotiations.
Payor contracts are almost always skewed excessively in the payor’s favor. However, knowing the renegotiation and contract termination dates can allow you to make use of your time and contract data to achieve more favorable payer contracts.
You should be automatically informed far in advance of any significant payor contract dates by using alerts and notifications in your contract management software. Set up notifications for significant deadlines 30, 60, 90, days (or any other duration) in advance. This gives you time to work with your payer contracting team and set up a plan.
5. Negotiate Better Terms
If you’ve taken time to learn your payer contracts, you may use that information to negotiate better reimbursement rates with payors – or determine if it would be wiser to search for another payor. You can renegotiate contracts and conditions more advantageous to your organization if you prepare evidence-based, data-driven replies. So, don’t simply take what is offered – think about what would be most beneficial to your healthcare organization and find supporting data to use during contract negotiations.
Payor Contracting with PayrHealth
Payer contract management is continually one of the most laborious tasks that healthcare providers face. The contract management process can be tedious and overwhelming, which is why partnering with an expert payor contractor can help. To learn more about how we can help you achieve the contract portfolio you want, contact us today for a free consultation.
