Contracts for healthcare pay are usually quite complex, which means that we have to observe and manage them closely. If there’s any neglect in this area, healthcare providers might not get properly reimbursed for their necessary services.
Since it’s challenging to keep up with all the terms, details, and agreements, healthcare providers risk missing deadlines for filing claims. Miscalculating payments is another concern. It ultimately puts everyone at a disadvantage. A healthcare administrator needs to understand such contracts fully so that nothing goes awry.
Wondering where to start?
Here is some valuable information about payor contracting.
Making Use of Software
With all the technology now at our fingertips, there’s no need to rely on manual systems. Several kinds of contract management software are available today. So, find out which goes best with your organization and start using it.
Such software enables healthcare professionals to store their payor contracts and organize them properly. They’ll also be in a centralized repository. This means that there’s no need to search through several devices whenever you need to reference a contract.
This step might mean some labor and effort in terms of converting the old systems but the benefits will be multifold. You’ll be able to say goodbye to time-consuming tasks such as tracking contracts within a spreadsheet. Errors will also go down, along with the complications and confusion that arise from multiple people working with one spreadsheet.
Getting into Contract Language
When you manage payor contracts, you need to have a proper understanding of their language. This knowledge is essential for understanding the clauses and requirements that might become obstacles later on.
Make sure you take a closer look at all the details in the contracts. They might have clauses about network requirements, unilateral amendments, and reimbursement policies. Be careful; you don’t want to end up making an agreement where the payor can make changes without your consent.
Reporting the Details
If you want to effectively manage your payor contracts, there should be insight and transparency in all the positions within them. This includes the rate, guidelines, amount of time to file a claim after service, time limit for reimbursement, and other specific requirements. Any recognition or termination clauses are also important.
Besides helping you adapt useful time management strategies, your software should allow you to tag the contract data in the system. You may then run some reports and see whether this information is clear in all your HPA payor contracting & credentialing.
Setting Reminders
Payor contracts are usually a bit biased towards the payor. As a healthcare provider, you have to be aware of the delays for both termination and resignation. That way, you can make preparations, take action, and decide whether the agreement terms need a change. You may also have to determine whether to stop working with a certain payor altogether.
When you use the notification and alert features in the contract management software, you’re updated about any important dates. Set reminders some days before any important dates so that you can evaluate the clauses and prepare accordingly.
Asking for Better Agreements
You don’t have to simply accept what they hand to you. When providers get better insight about payor contracts, they can use that information to find higher reimbursement rates. They might also look around for other payors to work with. Giving data-driven arguments and evidence will allow you to renegotiate the terms until they become more favorable to your needs.
The Takeaway
Understanding the structure of every single contract can be a bit challenging. However, using the right software in the proper manner will help you see what’s most important. You can then be able to take the necessary action to get the most favorable and best outcome for the organization you represent. Start researching the top contract management software today. You’d hopefully see a smoother and more lucrative system.
