Stop Leaving Money on the Table: Mastering Payer Contract management for Healthcare Revenue
Navigating the complexities of healthcare billing is challenging enough. then you add in the labyrinth of Medicare, Medicaid, and countless third-party payer contracts – each with its own unique rules, rates, and deadlines. Without a robust system in place, revenue leakage is almost inevitable.
Are you confident you’re capturing every dollar you’re entitled to?
Payer contract management software isn’t just about organization; it’s about maximizing your revenue potential and minimizing administrative burden. Let’s explore how these tools can transform your revenue cycle.
The High Cost of Manual Payer contract Management
Traditionally, managing payer contracts has been a manual, time-consuming process. This often leads to:
Missed Renewal Dates: Losing favorable contract terms due to oversight.
Reimbursement Discrepancies: Failing to identify underpayments or changes in reimbursement schedules.
Denial Risks: Errors stemming from misinterpretation of complex contract language.
Wasted Staff Time: Hours spent reviewing contracts and chasing down payments instead of focusing on patient care.
These inefficiencies directly impact your bottom line. Fortunately, there’s a better way.
How Payer Contract Management Software Delivers Results
Modern payer contract management software centralizes and automates key processes, offering significant benefits:
Centralized Contract Repository: All your payer agreements, amendments, and related documents in one secure, easily accessible location.
Automated Date tracking: Never miss a critical renewal or amendment deadline again. Receive proactive alerts to ensure timely action. Reimbursement Term Monitoring: Instant notification of changes in reimbursement rates, coding requirements, or other key terms. Seamless Workflow Integration: Link payer terms directly to your claims workflows for accurate and compliant billing.
Underpayment Identification: Automatically compare actual reimbursements to expected amounts, flagging discrepancies for investigation.
This isn’t simply better record-keeping. It’s about proactive revenue cycle management, reducing errors before they lead to denials and lost revenue.
Experian Health: A Proven Leader in Payer Contract Management
At OrthoTennessee, they’ve experienced these benefits firsthand. Frances Thomas, Manager of payer Strategy, relies on blank” rel=”noopener”>Experian Health’s payer contract management software to negotiate stronger settlements and terms. “The system gives us the details we need to be accomplished,” she explains. “They can’t really argue with you when you have the data.”
Experian Health’s blank” rel=”noopener”>Contract Manager and Contract Analysis solution takes this a step further. It proactively analyzes contracts to identify potential pitfalls – ambiguous language, complex terms, or overly restrictive coding rules – that could jeopardize your revenue.
here’s how it works:
Pre-Submission Claim Checks: Validates claims against contract terms before submission, minimizing denials.
Automated rate & Rule Population: reduces manual data entry and ensures accuracy.
Real-Time Alerts: Keeps your team compliant with changing payer requirements.
Expert Contract Analysis: Access to Experian Health’s team of analysts for in-depth contract review and guidance.
This thorough approach is why Experian Health’s payer software has been recognized as Best in KLAS for three years running.
Real-World Impact: Bulk claims Processing & Revenue Recovery
OrthoTennessee dramatically improved efficiency by leveraging bulk claims processing. “We had over 600 claims for one day in the wrong network,” Thomas recounts. “I was able to take that bulk of claims and handle those. Otherwise, I was going to have to sit there and go claim by claim. It’s a huge time saver to work smarter, not harder.”
