Providers manage the patients’ health and help those lead healthier lives. Intricate provisions and legalese in the payer contract tend to confuse and result in obstructing the patient outcomes.
The Provider’s reimbursement terms for providing patients with healthcare services pertaining to a specific plan is clearly defined and spelled out in Payer Contracts.
Timely, impeccable reimbursements and consistent revenue flow can be obtained through an extensive knowledge about Payer contracting.
To amplify the reimbursement and circumvent the claims it is imperative that providers and their practice executives have a thorough knowledge about the terms used in payer contracts to deftly negotiate and renegotiate contracts.
Eligible Amount is the fixed amount for which the provider can opt for reimbursement from the payer for a specific covered healthcare service. Hence the patient might be required to make some additional payment for covering the balance charges as the allowed amount does not cover the complete provider charges.
Flawless Claims are when the claims are error-free and smoothly processed without the need of any additional information. Mainly claim denials and reimbursement delays occur due to incorrect information, missing approval of the physician or incomplete documentation. The provider’s revenue has a serious effect when the claims are incomplete and have errors. The revenue collection is efficient if the clean claim rates are higher.
Plan for Fee is paramount in any payer contract which clearly lists out the fees for certain supplies and specific provider services. Attaching a detailed list for the fees defining clearly the covered services and negotiated prices if any is a must in the payer contract.
Medicinal Requisites are the supplies or healthcare services basically required for diagnosing a particular illness and for treating any illness or disease. Only those services which are considered medically necessary are being reimbursed by the payer to the provider. There are specific time limitations with regard to services provided within a certain period of time. When it is not a medicinal requisite, billing the payers for those services could lead to punishments.
Essential Network is paramount in Payer Contract. Being a part of the appropriate network for practice drives the revenue and expands the patient volume for providers.
Missing Payer payments and underpayments cannot be avoided. Unfortunately the health providers fail to identify and correct such imprecise payments and errors which evidently strains the revenue cycle.
The prime reason for denial of medical claims is simple human error. Even the slightest typo error can be the cause for instant denial. Business Integrity Services’ Payer Contract Management streamlines and checks carefully to ensure the claims are free of errors before submitting. We help you with automated access to the precise and appropriate data. Our Payer Contract Management enhances your bond with the payers while increasing your revenue by providing you with swift and accurate reimbursement.
The key to amplifying your reimbursement, avoiding claim denials and managing a smooth revenue cycle rests on a thorough understanding of the terms and provisions in Payer contract. Business Integrity Services efficient Payer Contracting caters to these needs and assists to drive revenue and expand the patient volume.