Dramatic changes in the economics of providing healthcare have created an increased reliance on healthcare contract management agreements, which has afforded MGSI is the leading medical billing company, the opportunity to ensure that our clients are getting paid appropriately according to their managed care agreements. Gone are the days when physicians could simply trust that they were getting paid fairly and accurately or in accordance with your executed healthcare contract. The reimbursement rate is only one piece of the puzzle. Often times there are not only marketing, service and accessibility issues, but there are also other elements such as precisely defining what benefits are covered, stop loss provisions, various incentives and provisions about how members are counted and properly allocated. Healthcare contracts are legal binding documents which need to be reviewed carefully. Many physicians sign contracts without challenging or negotiating payor rates.
Contracting with payors is not just a one-time event and then out of mind. Healthcare contract management involves performing an annual analysis. For instance, identifying your top 5 payors- what is the current reimbursement rate per your healthcare contract? What is the volume by patient encounters and revenue by the payor?
As your revenue cycle management partner we review each of our client’s fee schedules by payor. All government, managed care, commercial payors-etc. Fee schedule allowable rates are loaded into our practice management software at the CPT code level to ensure you are being paid based on your contracted rates. MGSI will identify on first pass if a payor is not reimbursing you based on your contractual rates and will take immediate action to have the payor rectify for future claims and provide correct reimbursement dollars. In addition for each payor the provider participates with MGSI identifies: the timely filing limit and time allotted to appeal a claim. This analysis is handled annually. How does your practice know if you are being paid accurately? How do you track the health payors claim edits which do not reimburse for certain services/procedures when billed with other services rendered? Is your practice up to date insurance company payment rules? Are you being kept in the know when your payors reduce your reimbursement rates?
At least one-third of the issues within a contract can be improved if you clarify these issues from the onset. Our thorough analysis of the contract ranges from procedure carve-outs to termination clauses to risk assessment. We ensure terminology is present that protects you; e.g., clauses allowing you to drop a disruptive or non- compliant patient.
Making sure your healthcare contract is a winner depends not only on evaluating your position in the market, but also working collaboratively, displaying flexibility and sharing data with the managed care organization. This will lead to an agreement that is win-win and to a long term payer-provider relationship
For more information on this service and how it can benefit your practice call toll free at 877-896-6474 or email info@mgsionline.com.
