If you run a medical practice, you know how vital payer contracts are for your revenue cycle. A payer contract defines the reimbursement structure and schedule for the medical services you provide to the patients with a specific health plan. In addition, it explains things like reimbursement rates, provider networks, benefits, credentialing, medical necessities, and more.
Understanding payer contracts can help you optimize your practices and ensure you always get reimbursement on time. In addition, negotiating better contracts can help you maximize your practice’s revenue.
Read on to discover how you can maximize your revenue with payer contracts, what you need to consider before accepting a specific payer contract, and who can help you with credentialing and payer enrollment in Houston, Texas.
What to Take Into Account to Boost Your Revenue With Payer Contracts
The credentialing and payer enrollment process can be long and challenging, which is why many healthcare providers decide to outsource these procedures to professionals. That way, you can get an expert to negotiate a better payer contract for your practice, which is essential for your financial well-being.
If you want to handle the process by yourself, you need to understand the basics of payer contracts, the language, and how to prepare for negotiations. Master these, and you’ll be able to maximize your revenue.
Understanding Payer Contract Basics
Payer contracts may seem complicated at times, which is why you need to understand the basics to be able to prevent denied claims and maximize revenue. Most healthcare providers only know the terms that refer to reimbursement rates for commonly billed services. However, you should understand other vital aspects of a payer contract, such as:
- Claim submission window
- List of services covered by a payer
- The reimbursement timeline for provided services
- Claim denial and dispute procedures
- Reimbursement rates for all procedures
- Renegotiation and termination guidelines
- Contract duration
Understanding all of these terms will help you maximize revenue and improve the financial side of your medical practice.
Consider the Language of a Payer Contract
Once you understand payer contract basics, you need to dive deeper into the verbiage. Certain clauses and requirements can hurt your revenue, which is why you need to understand everything before accepting the proposed contract.
For instance, unilateral amendments allow the payer to change the contract with minimal notice. That includes the reimbursement rates and different requirements. Because of that, you need to investigate these clauses and discover how much time you have to object to the changes and renegotiate them.
Other terms you need to pay attention to include reimbursement policies, medical necessities, network requirements, and credentialing.
Preparing for Payer Contract Negotiations
A payer doesn’t hold all the cards regarding contract negotiations. You should analyze performance data and use it to your advantage to renegotiate better reimbursement rates and other terms. However, developing a data-backed negotiation plan isn’t easy, so you’ll most likely need professional help for this.
Revenue Cycle Management in Huston, Texas
Peregrine Healthcare should be your first and only stop if you’re looking for somebody to tackle revenue cycle management and contract negotiations for your practice. We have extensive experience in the medical industry, and we know how to maximize your revenue by implementing changes in every step of your revenue cycle.
Click here for our contact info, and we’ll gladly discuss how we can help boost your revenue.
