Payor Contracting

Why Every Provider Should Practice Payor Contracting Analysis

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Taking payor contracts and fee schedules for granted is one of the key causes of many healthcare organizations’ inability to turn a profit. If you don’t have a detailed approach to examining payor contracts and reimbursements, your practice may be compensated based on an antiquated and unfavorable payor fee schedule for services. Paying special attention to your contract terms, reimbursement rates, data, coding process, and more helps you identify areas for growth and gives you the knowledge to make informed decisions about your practice – and ultimately improve your revenue cycle. Here’s what to know about examining your payor contracts and how healthcare organizations can benefit from professional payor contract management with PayrHealth.

Achieve Better Reimbursement Rates

This is arguably the most important reason to practice good contract management. Better reimbursement rates will only improve the financial health of your revenue cycle. By knowing your current fee schedule, you can negotiate for more favorable rates in your contract terms. Boosting your revenue cycle with more net revenue allows you to focus more on your patients and growing your presence in your area, not wondering why it feels like you get so little for services rendered.

Negotiate Contracts More Productively

Negotiating new payor contracts (which you should do often) can be overwhelming if you don’t know the ins and outs of your contract terms. Payors will always want to come out ahead of a contract negotiation, and the best way to negotiate productively is to be prepared with information. It can give you the chance to get rid of any unnecessary complexity or vagueness that might be causing difficulty for your staff. When you know what you don’t like about your current contract, you can ensure your new one offers a more favorable deal.

Better Understand Your Practice’s Unique Challenges

It can be difficult to negotiate a better position for your healthcare providers if you don’t understand what their issues are. Taking some time to determine which contract terms interfere with patients’ quality of care is fundamental to making informed decisions about your practice and payor participation. If you can quantify, track, and measure against your current contract, it will only help. You can identify steps in your billing and coding process that could be streamlined by a more robust contract, too.

Reinforce Accuracy

Being on the same page is key when interacting with payors throughout your billing and coding process. If you’re expecting one thing and your contract says you’re getting another, it can cause frustration. Managing your payer contracts can ensure less back-and-forth and (most importantly) reduce claim denials – saving your staff time and resources at every step. This goes hand-in-hand with the above point – understanding your team’s challenges allows you to ensure your contract meets the needs of your process, not the other way around.

Reduce Unnecessary Complexity

Especially in old, stagnant contracts, complex addendums and clauses can make the whole process more difficult. Review, identify, analyze, and understand exactly what about your payor contract is causing your staff difficulty, and determine how you could improve it with simpler, more well-defined terms when you make changes with a contract renegotiation. The impact can be much bigger than you think, especially if your team currently has to use workarounds or complex steps. Additionally, you can improve patient satisfaction by reducing errors, speeding up payments, and spending more time on care.

Knowing What Questions to Ask

Many practices identify hardships or pain points with their payor contracts but don’t know how to implement changes. Understanding and evaluating your contracts gives you the ability to ask the right questions during negotiation and implement solutions accordingly. For example, wondering why your reimbursement rates seem low is less helpful than knowing where they measure against the market value for the same service.

Complete Payor Management with PayrHealth

At PayrHealth, we offer complete payor management to help you negotiate better contracts for your practice. Our experts can help you learn more about the right payor contract for your needs and give you strategies to negotiate for a better one. We can analyze your contracts and help you find ways to maximize payments, get better reimbursement, and allow your team to streamline their process. We can provide data-driven insights and even help you measure and compare results from your contract negotiation. In short, we can support you at every step of the way to help you access the contract your practice deserves.

Payor contracts can be complex and difficult to manage when you have patients to care for. At PayrHealth, we have combined decades of industry experience in helping healthcare providers achieve better reimbursement rates, revenue, and patient quality of care. To learn more about how we can help your healthcare providers thrive, contact us today for a free consultation.

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