What is Healthcare Contract Management in Medical Billing?

13 October 2022
What is Healthcare Contract Management in Medical Billing

Healthcare facilities and Providers link themselves with several insurance companies to benefit patients with different insurance policies. Doing so makes it easier for them to tend to the appropriate one. Certain legal documents get signed, including the details of the various medical services rendered and their repayment information. These are known as healthcare contracts.

In most cases, the crucial clauses affecting the contracts get overlooked by most providers as they tend to focus mainly on rendering quality patient care. Other than this, several other factors, such as the benefits covered, incentives, provisions to avoid loss, issues caused due to service and accessibility, and specific requirements that help count or allocate members, must be carefully analyzed and adequately managed. Failing to do so causes delays in the payments for Providers or results in improper payments.


What is a Healthcare Contract?

A traditional contract binds two consenting parties. Generally, it is the physician, the healthcare provider, the organization for health maintenance, an integrated delivery system, or a managed care organization (MCO) similar to a provider-sponsored network or another distinct healthcare plan that gets referred to as a healthcare contract.

Besides this, there are other contracts that get bound between the healthcare providers and several other vendors, employees and many others. Mainly, these contracts focus on the responsibilities and roles of the individual party and the need for firm adherence to federal and state laws.


What are some of the common types of healthcare contracts?

Some of the common types of health contracts are as follows:

1. Contract for Physician Recruitment
2. Contract for Physician Enrolment
3. Contract for Medical Director
4. Contract for Patient Transfer
5. Contract for Equipment Lease
6. Contract for Managed Services
7. Contract for Purchased Services
8. Contract for Technology Licensing
9. Contract for Joint Venture
10. Contract for Supervision Agreements
11. Contract for Executive Compensation and Employee Benefits Arrangements
12. Contract for Media and public relations


What are some of the best practices of Healthcare Contract Management Services?

To ensure that your healthcare facility is compliant with terms and regulations, laws, conditions and mainly confidentiality all the time, it is essential to follow the below best practices for healthcare contract management:

1. Standardize the contract Process

The contract process needs to get standardized, as several submissions, approvals, corrections and signatures get needed for the various contracts created and moved around within the healthcare organization.

By doing so, you can reduce the mistakes and minimize wastage of time as you can get assured of completing the required tasks during each step of the contract drafting.

2. Automated workflow and process

A best practice that can’t afford to get skipped is electronic health record management. You can have a seamless workflow with enhanced health analytics while managing health informatics far better by choosing this best practice, automation of your healthcare contract management. Not only that, you can improve patient engagement and thrive in the healthcare business with the quickened process of drafting and reviewing the healthcare contract administration.

You can efficiently manage the creation and revision of the contract as automated workflows provide transparency in healthcare management. Consistently sending reminders to the individuals about the contract and the dates of termination and other prime obligations required are managed seamlessly with automated workflows and processes.

3. Ensure to link the contracts to Policies and Procedures

Managing regulatory compliance and strictly adhering to the various guidelines about security and privacy is all about medical contract management. It is highly essential for healthcare organizations to ensure HIPAA compliance and also that the patient medical records and medical billing are well managed.

Adopting electronic contract management is highly recommended in healthcare and policy management systems as it ensures a seamless contract link to suitable policies and procedures. With adept healthcare payer contract management software, you can be particular about seamless integration from a compliance point of view.

4. Centralized Repository

Efficiently organizing the various files is essential as the healthcare industry has extreme paperwork. Hence, these files must be in a central place as that would provide instant access to the files. Several tasks, such as placing custom tags, having various options to conduct an advanced search to locate specific files and folders, editing particular viewpoints to get clarity, Etc., are included.

Doing so allows you to finish specific tasks such as reviewing the contract, and decision-making based on particular information gets carried out way quicker than usual.

5. Extensive Reporting

Once the healthcare contracts get organized and on time, automated alerts get sent for meeting the deadlines. The foremost critical step is reporting; establishing specific data reporting after working with the risks and compliance terms get needed for improved contract transparency and regulatory compliance.

6. Creation of a database for commonly used Contracts and Clauses

With the help of a legal team, you can create a database for all those commonly used healthcare contacts and clauses. And also automate those into suitable contracts to reduce the firm’s wastage of time.

It can also convert specific standard contracts into templates that benefit the system storage.

7. Optimization of security

While electronic contracts are stored, it is imperative to take high-security measures as susceptible data are contained in the contracts to avoid a data breach.

Hence it is of utmost importance to ensure server compliance with the necessary regulations and rules. You need to set up a user hierarchy and two-factor authentication and adequately ensure to offer a user with either full or partial access or a no view status. To avoid unauthorized sharing, it also recommended having digital watermarks on the healthcare files.

Go digital and streamline your healthcare contract management with BIS

Healthcare is a rapidly moving and highly competitive industry where time is considered money. Hence digitalization and adopting certain best practices aid in streamlining the entire process. You can reduce the costs involved, meet your regulatory compliance terms and manage the ever-increasing demand for patients’ personalized services seamlessly.

Business Integrity Services, with its proficient team, is happy to offer a helping hand to help you focus better on the core competencies and relieve you from having to manage the non-core tasks while steadily improving the patient experience. Our experienced team is ready to support and guide you through a streamlined process of Healthcare contract management services.


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