HCPro.com: Managed Care Contracting and Reimbursement Advisor

Managed Care Contracting & Reimbursement Advisor tells you exactly what you must know and do to successfully negotiate the best deal with HMOs, PPOs, and other payors - and get bigger and faster reimbursement!

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February 2008 (Volume 5, Issue 2)	view entire issue

Fix and resubmit rejections to minimize payer denials
Optimizing denial prevention strategies can help your practice improve cash flow, according to Elizabeth W. Woodcock, MBA, FACMPE, CPC, an Atlanta-based healthcare author, trainer, and presenter at the Medical Group Management Association (MGMA) 2007 Annual Conference in Philadelphia in October. Focusing on charges as the root cause of denials and improving performance in this segment of the revenue cycle is an essential first step to managing denials, Woodcock said. Providers can perform manual charge scrubbing by distributing their paper charge tickets by payer-for example, charges for Medicare to the individual in your office who works on follow-up for Medicare.

Organize your contracts to improve negotiating clout
Payers are achieving claims savings today by digging into the pockets of providers and consumers. Providers have accepted pay cuts during contract negotiations, and members have been stuck with rising copays and deductibles. Although providers have little sway over the benefits in employer-sponsored health plans, they can at least halt the erosion of practice revenue and physician income by assembling a matrix of their contracts, assessing their current payments, and forcing payers to the table with good data, according to Penny Noyes, president of Health Business Navigators, a consulting and provider contracting firm based in Bowling Green, KY. Noyes presented negotiating and contracting strategies at the Medical Group Management Association (MGMA) 2007 Annual Conference in Philadelphia in October.

E-tool: Sample ContractMaster


E-tool: Sample payer summary

Other recently-published articles from Managed Care Contracting and Reimbursement Advisor:

Cash in on Medicare bonus for e-prescribing

Involve physicians in your managed care contract negotiations

Use lean cost accounting to examine your cost structure

Bridges to Excellence pays bonuses to docs for implementing medical home

Ensure that contracts cover real-time claims adjudication

Build a defensible fee schedule to challenge lowball payer contracts

Use retail clinic referrals to boost your bottom line

E-visit payment promising but not ready for prime time

Think twice before opting out of Medicare

Prepare for contracting challenges during mergers, consolidations

E-tool: Sample letter to payer on intention to renegotiate

E-tool: Payer/MCO contract provision samples

Watch your contracts in the wake of ’final’ Stark rules

Put these provisions on your managed care contracting hot list

Audit your patient financial services department to maximize your managed care reimbursement

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