Healthcare payor contracts are often intricate legal agreements that, if not properly handled and overseen, may provide significant difficulties for healthcare providers. They specify how healthcare professionals are paid for providing treatments to patients insured by certain health plans; this includes everything from medical necessity and provider credentialing to provider networks and payment rates.
Healthcare providers sometimes miss deadlines for filing claims and fail to satisfy requirements for timely compensation because of the difficulties in adhering to these agreements and learning all the terms and nuances. This may lead to providers not getting all their reimbursements and calculating income streams incorrectly, which may hurt your bottom line.
For this reason, hospital and practice managers must comprehend payor contracts to guarantee that your company is paid appropriately for services provided without spending additional time following up with payors. The following five pointers will assist you in creating a strategy for handling healthcare payor contracts successfully.
1. Store and arrange payor contracts using contract management software.
With contract lifecycle management software, providers may store all payor contracts centrally, saving them the trouble of constantly rummaging through shared files for a particular contract whenever needed. Labor-intensive manual procedures may be time-consuming and prone to mistakes, such as keeping contracts in a spreadsheet and storing them on many shared drives. When many individuals use the same spreadsheet, things become much more difficult.
2. Examine the contract content in further detail
Anyone who oversees payor contracts has to 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 amendments—that is, the ability of payors to alter agreements without the provider’s approval.
3. Provide an overview of the key clauses and information in payor contracts.
To manage payor contracts effectively, you need visibility and understanding of every clause in your agreements. That includes, of course, the different rates of reimbursement and guidelines. Still, 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.
You can run reports to examine how this information differs across all contracts in your portfolio using the feature many contract management software systems offer: the ability to tag all contract data inside the program.
4. Set up calendar alerts for dates of termination and renegotiations.
Payor contracts in healthcare are often skewed excessively in the payor’s favor. However, Healthcare providers may better plan to act and decide whether to modify an agreement’s conditions or continue working with the payor if informed of renegotiation and termination dates.
You should be automatically informed far in advance of any significant payor contract dates by using the alerts and notifications provided by contract management software. You will have plenty of time whether you set up notifications for significant deadlines 30, 60, 90, or any other duration in advance; you will have ample time to assess every agreement and suitably organize your subsequent actions.
5. Negotiate better terms in negotiations
Providers may learn more about your contracts, including their performance and content, using the previously stated reporting feature. After that, you may use that information to negotiate better reimbursement terms with payors or determine if it would be wiser to search for another payor. You will renegotiate contracts and conditions more advantageous to your organization if you prepare evidence-based, data-driven replies.
The majority of healthcare providers have contracts with several commercial and government payors. Therefore, it may not be difficult to comprehend each specific arrangement’s terms completely. However, you can more quickly see the most crucial data in your contract portfolio and take calculated action to get the greatest outcomes for your company by implementing contract management software to improve your contract management process.