Enhancing Revenue Through Effective Payer Contract Management

Key Challenges

Contract Complexity: Managing a diverse range of fee schedules and administrative tasks can be overwhelming. Additionally, regulations like the No Surprises Act introduce further complications.

Steps for Payer Contract Optimization & Management

1. 1. Centralize Contract Information

      • Gather all relevant contract documents.
      • Focus on critical details such as pricing, payment terms, and renegotiation timelines.

   2. Perform Revenue Analysis

      • Utilize analytics to identify the most profitable contracts and pinpoint areas for improvement based on medical services being rendered.
      • Evaluate how reimbursement rates affect overall profitability.

   3. Detailed Pricing Information

      • Secure precise details about reimbursement rates, including the effects of modifiers and multiple procedures.

   4. Understand Terms and Targets

      • Ensure you understand the specifics of termination clauses, deadlines, and other fine print.
      • Get a clear understanding of complex terms in value-based contracts.
      • Work with your team to manage these terms effectively.

   5. Payment Discrepancies

      • Compare expected payments to actual receipts to spot and address any variances.

   6. Conduct Cost Analysis

      • Assess the cost of delivering services compared to reimbursement using methods like cost-per-RVU analysis.

   7. Evaluate Administrative Efforts

      • Analyze the burden of authorization requirements, charge denials, and appeals.

   8. Formulate a Negotiation Plan

      • Use data to construct a compelling case for better terms.
      • Take into account the practice’s unique strengths, patient satisfaction, and efficiency in clinical operations.
      • Use collected data to mitigate financial risks, negotiate improved terms, and reassess payer relationships.