Information: Tailored to you and Your Clients
Are you contracted at payment levels on par with other physician groups or medical services?
Compensation levels should be at market or higher.
Does your existing contract language and procedures favor you or the payer?
Timely payment provisions, slow pay penalties, clear appeals process and absence of “lesser than” language.
Are your bills and resulting payments undermined by “silent PPO” and payer underpayments?
Payers may “cherry pick” from other agreements to justify lower payments.
Are you being paid according to your contractual agreements?
Payment schedules should be clearly defined and payments routinely audited.
Will your coding practices withstand a commercial or Medicare recovery audit contractor (RAC) review?
Hospital services are now subject to RAC; it’s likely other physician/medical services will be included in the future.
Should you consider terminating some insurance and network contracts because they are costing you more than they return?
Annual contract performance reviews will indicate low utilization, poor payment performance and over-use of staff time and resources.
Are you aware of patient mix and payer mix trends affected by market developments, mergers and transitions?
Continued decreases in HMO membership; significant growth in Medicare Advantage and Medicaid membership; health plans purchases and closures: what does it mean for your practice or medical service?
Are you billing worker’s compensation payers effectively and are worker’s compensation payers providing reimbursement comparable to other providers? Are you contracted with worker’s compensation plans/networks?
By law, all employers must have worker’s compensation insurance or self-fund it. This is “first dollar” coverage with no deductibles or co-pays that must be provided for an injured worker.
Are you effectively using referral development and outreach strategies to maximize utilization under your existing agreements?
When a contract is signed, the important work is just beginning. There are strategies to maximize use of your services by other network providers and members.
Does your billing staff, processes and technology effectively capture and manage all payment opportunities?
An outside review, new technologies and application of billing techniques and follow-up can make a difference.
Medical Practice & Services-Management Resources
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