Payer
Reimbursement Analysis

Our Payer Reimbursement Analysis provides tailored insights, empowering providers to optimize reimbursements and navigate complex payer landscapes with confidence.

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SOLUTIONS

Boost Your Earnings And Expedite Payments With Better Payer Contracts

Our team of experts specializes in conducting thorough and comprehensive payer contract analysis to identify the strengths, weaknesses, and improvement opportunities of your existing contracts. Once we have an understanding of the terms and conditions, we take the time to explain any potential threats and risks associated with unsatisfactory contracts, ensuring that you are fully informed of the negotiation needs

Experience Smarter Contract Negotiations For Better Results

TriumpHealth’s team of seasoned financial consultants conducts an exhaustive review of your contracts to gain a thorough understanding of the contract terms and analyze the language utilized by the payers. This payer contract analysis process enables us to discern crucial factors that provide providers with leverage during negotiations. Our consultants possess an elevated level of comprehension of these essential elements, allowing for a more comprehensive and effective analysis of payer contracts. Take a look at the factors mentioned below:

Fee Schedule
Reduction Rates
Relative Value Units (RVUs)

Timely Filing Rules
Patient Volumes
Claim Filing Limits

Appeals Qualifications
Market Value Based on Taxonomy

Get Ahead Of The Competition With Us!

In the ever-evolving healthcare industry, staying ahead of the competition requires a reliable and trusted partner that can provide expert advice on payer contract analysis and payer contract negotiations. That’s where TriumpHealth’s experience with payer networks comes in handy and is valuable to you. Get in touch with us today to learn more about how we can assist you in maximizing revenue and staying ahead of the competition.

Frequently Asked Questions

What is the significance of payer contract analysis for healthcare providers, and how does it impact their financial performance and reimbursement rates?

Payer contract analysis is crucial for providers as it directly impacts financial performance and reimbursement rates. By evaluating contracts, providers can negotiate better terms, maximize reimbursement rates, and identify revenue opportunities, contributing to financial stability and operational efficiency.

How do you conduct a comprehensive analysis of payer contracts, and what key elements or terms are typically assessed during this process?

We review contract terms, fee schedules, reimbursement structures, and performance metrics. Key elements include payment rates, coverage limitations, claims processing procedures, and contract renewal terms, allowing us to assess financial implications and align contracts with practice goals.

Can you explain the methodologies and tools you use to evaluate the financial impact of payer contracts on healthcare practices, including considerations for fee schedules, reimbursement structures, and performance metrics?

We utilize financial modeling and analysis to project revenue under different contract scenarios, examining fee schedules for underperforming codes and assessing performance metrics like claims denial rates. Advanced software systems streamline data analysis, facilitating informed decision-making to optimize reimbursement and financial performance.

How do you stay informed about changes in payer policies and industry trends, and how does this information influence your payer contract analysis strategies and recommendations?

We monitor regulatory updates, participate in industry webinars, and maintain communication with payers and associations. This informs our team, enabling us to anticipate changes, adjust negotiation strategies, and make recommendations aligned with practice objectives.

Can you provide insights into the impact of effective payer contract analysis on the overall operational efficiency and financial stability of healthcare practices?

Having an analysis completed helps streamline claims processing, reduces administrative burdens, and improves cash flow management. Optimized reimbursement rates and performance metrics lead to increased revenue and profitability, ensuring long-term sustainability and success for healthcare practices.

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What Values Can TriumpHealth Deliver to Your Organization

Understanding Your Driver For Payer Contract Negotiations

We first listen, to understand your needs and goals for payer contract negotiations; then provide customized, value-added solutions. For instance, which one or more of the following reasons is causing you to consider negotiating your payer contracts:

Increase in Revenue
Expanding your Payer Network
Increase the Patient Base or Lives Covered
Higher Market Penetration
Become More Competitive in Your Jurisdiction

You Can’t Manage What You Can’t Measure

To help you manage your revenue, we conduct a thorough payer reimbursement analysis, including:

Identifying high-volume and high-value medical procedures and services rendered at your medical practice or healthcare organization
Reviewing the fee schedules and reimbursement rates of payers you want to negotiate with for above procedures and services
Analyzing the payer’s reimbursement policies, such as deductibles, copayments, and coinsurance, to understand how they affect the amount you will be reimbursed for each claim
Researching gaps in reimbursement between contracted amounts and payments received for specific CPT’s

Establish Key Payer Contract Negotiation Differentiators

When requesting a reimbursement rate increase, we help illustrate the value you offer to the payer, as compared to the competing healthcare organizations in your jurisdiction. For instance, does your practice offer services in multiple languages, or extended business hours during weekdays, or telehealth appointments etc. Similarly, do you have expert providers in niche areas of your specialty that can cater to specific patient diseases.

Data-Driven Negotiations

Our Process

Fee Schedule Evaluation

Collect and review the practice’s current fee schedule for services rendered, including procedure codes, associated fees, and any modifiers. Assess the fee schedule’s competitiveness compared to industry benchmarks and regional averages.

Payer Reimbursement Analysis

Analyze reimbursement rates from various payers for services rendered by the medical practice. Evaluate the consistency and adequacy of reimbursement rates across different payers, considering factors such as contracted rates, fee schedules, and payment methodologies.

Contract Negotiation Assessment

Assess the effectiveness of payer contracts in meeting the practice’s financial goals and objectives. Evaluate contract terms, reimbursement rates, payment methodologies, and performance incentives to identify opportunities for negotiation or renegotiation with payers.

Financial Impact Analysis

Calculate the financial impact of fee schedule adjustments and payer reimbursement changes on the practice’s revenue and profitability. Conduct scenario analyses to forecast potential revenue gains or losses based on different fee schedule modifications or contract renegotiation outcomes.

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.