Now you can perform reporting and business intelligence with ease. Therefore, payer contract management is key to ensuring payers reimburse practices and hospitals the correct amount each time a claim is submitted. Underpayment Detection Accurately detect underpayments Payer contract management for Medical Groups, Hospitals and Health Systems. We make it easy to store your contract files, set reminder dates, and display your rates publicly to ensure you meet the mandate. Hospital / Payer Contract Management Software & Services Maximizing Provider Revenue with Payer Contract … Backed by an industry leading 99 percent calculation accuracy rate, PMMC’s contract management system identifies the most critical payment variances, so your hospital gets paid quickly and accurately. Payor-Provider Contract Management: How to Avoid Becoming a Horror Story September 23, 2013 ... payer sources will increase as a percentage of total for most providers. For example, Medicare manages the Physician Fee Schedule (PFS). Managing and Measuring Payer Performance Let us help you make sense of the growing volume and complexity of payer contracts and gain leverage when negotiating with payers. Each payer contract should have a fee schedule attached, and providers should push payers to provide a complete fee schedule. Managing and Measuring Payer Performance. A robust healthcare contract management software will track money owed and money underpaid by payers. The physician contract management system uncovers the most critical underpayment and tracking errors, so your collections staff can work more efficiently and collect more revenue. Denials should be managed with the same precise data-driven management. While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5 to 12%, per market. Learn More With Payer Management, you can eliminate revenue leakage and minimize non-compliance in your payer agreements. Payer contracts contain fee schedules and reimbursement requirements, as well as the conditions payers must meet for timely reimbursement. Maximize revenue by quickly identifying variances Uncover the most critical underpayments and denials trends When it comes to payer contract management, knowledge is power. Improving payer contract management by analyzing terms and assessing payer performance can maximize revenue for healthcare providers. April 20, 2018 - Ensuring correct reimbursement in a timely manner is always at the top of a healthcare provider’s mind. Subscribe to Codify and get the code details in a flash. Managing the increasingly complex reimbursement models of commercial and government payers is absorbing elevated levels of hospital resources – and with no assurances that contracts are tenable or will lead to financial stability. The essential tools of managing payer contracts allow providers to monitor, track and manage negotiated contract terms and rates. The Current Procedural Terminology (CPT ®) code 99499 as maintained by American Medical Association, is a medical procedural code under the range - Other Evaluation and Management Services. It will identify what the healthcare system, hospital or practice should be paid with combined payer contracted rates, contractual language, EDI billing data and remit data. HealthBPM can help you improve your payer contract management by fully using the functionality within Epic’s Resolute module for both physician and hospital billing. When you partner with PayrHealth, you get dedicated industry experts who will create a payor contracting strategy, secure and negotiate contracts on your behalf, and report on our progress through our portal and in regular reporting check-ins. Using the PFS, CMS reimburses for physician services under Medicare Part B. Increased visibility Gain visibility and control into payer revenue management process to ensure right payers are getting the right discounts. The best tools … sight in your payer contracts. Managing payor contracts is one of the primary challenges that every healthcare provider faces. Healthcare providers should have a contract management system as the framework for managing the four components of the governance/communication processes―contract analysis and modeling, payment calculations, variance monitoring workflow, and payer scorecard and reporting. Complexities that stand in the way of contract optimization By taking this important step, you will more effectively manage your: Our payer management experts do all the work of rounding up your contracts, so you can focus on running your practice. Payer Contract Management. Based on all contracts at the organization, administrators can create a standard version of a payer contract and use that contract when negotiating with payers. With the ability to understand payer contracts comes the ability to renegotiate terms that favor the provider organization. When implemented, the tools create a knowledge base that can empower staff to monitor contract compliance- and improve revenue. Payer negotiated rate data represents the core of the CMS Price Transparency mandate. From varying reimbursements to issues accessing networks and managing hidden clauses, contracts represent a major hurdle that affects every provider, regardless of size. Once practice or hospital administrators understand the basics of payer contracts, they can start to dive deeper into contract language. Understanding common clauses and requirements included in the majority of contracts will improve payer contract management and help provider organizations protect their revenue. Occasionally, payers may accomplish these reductions by terminating an older agreement with very favorable terms of reimbursement for the healthcare organization, so that they Optimize hospital and physician billing with Epic Resolute. Payer contract optimization can be one of the most valuable strategies, as once a contract is optimized, the practice reaps higher reimbursements for the entire duration of the contract’s term – without major process improvements or staff additions. 2. Hospitals are reacting to changes in healthcare finance by deploying vertical integration strategies. That’s the ultimate goal. Manage all your payer contracts and negotiated rates in one place. Complete payor management is an ongoing relationship rather than a one-off project, which means we will continue to get to know your … Maximize revenue and get reimbursed accurately on all payer contracts with PMMC's physician contract management services. 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