FROM CONTRACT TO PAYMENT: IS YOUR FACILITY GETTING WHAT IT’S ENTITLED TO?

The art of successfully negotiating payor contracts, is critical in navigating today’s healthcare environment of rising costs, increased regulatory scrutiny, and shrinking reimbursement rates and margins; and laying the foundation for a stable future in positive revenue flow.

Do you have a capable contract and reimbursement team in place that can monitor the provisions of commercial payor contracts, stay on top of amendments, and tie contracted rates to actual payments to ensure your facility is receiving what it is due? Critical factors to consider as you evaluate the strength of your processes:

• Are you familiar with the details of your top commercial payor contracts?
• Do you have internal controls in place to ensure the full realization of contracted rates?
• Do you have a robust contract management system and expected payment calculator?
• Is there a standard and consistent procedure to audit payments received against payor contracted rates to test for payment accuracy?
• When errant payments are detected, do you have a protocol to notify the payor for claim reprocessing or system corrections?

By addressing these critical questions, revenue pitfalls can be avoided, including “lessor of charge” payments, erroneous payments, claim processing system errors, and failing to appropriately cover the cost of services rendered, especially for services reimbursed at a percent of charge.

MedCom can help you evaluate key operational processes that impact Payor Contract Management with:

• Payor Contract Analysis;
• Charge Master/Pricing Assessment;
• Implant Charge Capture; and
• 837/835 Payment Analysis

About MedCom Solutions

MedCom Solutions creates patented technology and state-of-the-art software to help health care providers meet rapidly escalating and changing revenue cycle demands. Our Chargemaster, Pricing, Reimbursement, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.

Learn more about our solutions or visit our homepage or contact us today!