US healthcare facilities and companies sign up contracts with a wide range of insurance companies every year. All payers have different policies, standards, parameters and regulations to follow. Therefore, keeping track of all contracts is an enormous task, especially when the US healthcare industry is observing so many new reforms like the ICD-10 Code Set Implementation. To streamline the contract and policy management processes, Providers should consider outsourcing to medical billing companies. This way, they will get paid as per their managed care agreements. Let’s delve deep into the topic:
What is Healthcare Contract Management?
Patients have different insurance policies and to tend to them, Providers and healthcare facilities tie-up with many insurance companies. They sign healthcare contracts that are legal documents containing medical service repayment details. In this fast-paced, competitive industry, time is money! So, most Providers focus on patient care and overlook the vital clauses affecting the contracts or negotiate a good rate. There are also other elements like what benefits are covered, stop-loss provisions, incentives, service & accessibility issues and provisions for counting/allocating members. All of these factors have to be properly analyzed and managed. If not, Providers will experience delayed and improper payments.
Recurring Event:
Providers and healthcare organizations signing up contracts with Payers is not a one-time event. It happens every year! So, they have to re-credential with each Payor annually. The contract rates of each insurance company are revised and updated, yearly. It’s not an easy task to review each Payor’s updated policies and contract rates every year. To do that, Providers will need the help of medical billing companies.
What does an Experienced Medical Billing Company Do?
- An outsourcing company identifies the top 5 payors of a Provider/healthcare facility and check if they pay as per the contract.
- It creates and maintains a database to manage healthcare contracts. The database shows the policies and fee schedules of different Payors. For easy accessibility, the Payors are differentiated into Government, managed care and commercial.
- Using this database, a medical billing company can easily track payments. Also, it can identify which Payor didn’t pay and analyze the next steps to get the owed payments.
- The company does a thorough analysis of the Payor’s contracts and keep an eye on what is changed and what remains.
- It outlines procedural details and risk mitigations while enunciating key clauses and offering unlimited templates during the re-credentialing of the healthcare contract management process.
About MGSI:
If you are looking for a reputed and skilled healthcare contract management company, then MGSI is your best bet. Whether it is credentialing or re-credentialing, this Florida-based medical billing company takes care of everything as it has more than 20 years of experience in the domain. One of the best medical billing companies in the US, MGSI will negotiate the right agreement that will create a long-term Payor-provider relationship. To learn more details, log on to www.mgsionline.com.