Healthcare providers being underpaid by complex medical contracts need to mitigate risk and understand trends. Here are four ways to develop the best course of action for managing your contracts.
1. Adopt an integrated and proactive approach
A savvy contract management system can and should add efficiency to all revenue cycle processes at your hospital or healthcare organization that are dependent on net revenue while providing seamless integration among disparate data environments. It connects the dots by monitoring complex commercial payor contracts and capturing all rightfully earned revenue. The demand associated with multiple medical facilities, multiple contracts and multiple data sources requires a unified, systemwide platform. Identifying systemic payor issues and underpayments to recover lost revenue will resolve recurring issues while also providing the foundation to protect long-term revenue.
2. Understand contract performance
It is imperative that healthcare leaders know how well their contracts are performing for both their hospital and ambulatory services. Is your Patient Access office effectively collecting every dollar that is being billed out? Consider the physician’s side of the business, where the volume is tremendous, but the variances are slight. How do you collect massive amounts of data into an effective workflow? Or, have you examined other areas for improvement, such as month-end reserves? With a robust pricing engine, your contract management system should lend industry-leading flexibility, accuracy and efficiency to the entire revenue cycle process.
3. Drive contract modeling through collaborative investigation
Whether you lead one hospital or multiple hospitals, a successful contract management system provides significant in-house expertise so your teams can be free to focus on more critical tasks. Take a closer look at how your Managed Care team is negotiating contracts on behalf of the health system. How well is Patient Access collecting on incoming patients by generating patient estimations? Draft “what if” scenarios to prompt discussions across teams that identify and model projected financial impact, such as:
- What if I want to apply an across-the-board charge increase of 6 percent to my Charge Description Master (CDM) or model today’s CDM to determine future financial impact?
- What if I want to change my stop loss?
- What if I want to add new service types or new lines of business to my proposals?
- What if I want to convert a simple contract to a series of complex contracts?
- What if I import cost? What’s my profitability at the contract and account levels?
These scenarios will help facilitate negotiations by enabling team members to visualize complex situations that can arise. Examine these scenarios side-by-side to compare and contrast revenue impact across facilities and determine profitability at the contract and claim management levels. This activity will highlight areas where contract management’s innovation can leverage historical data and simplify the reimbursement process. Begin with asking the question, “What does my data say compared to my contract?”
4. Garner a competitive edge
Data not only provides a picture of consumer behavior, but it can also be a tool to help adapt to upcoming changes. What steps do you currently have at your medical facilities to manage changes in payor policy and procedures that can impact collections? Through the correct application of healthcare data analytics, leaders can better understand underpayment trends to mitigate compliance risk. Audits and audit protections apply meaningful context to data variations and map the company’s performance. nThrive Contract Management provides a competitive edge with the following:
- Accuracy – The most accurate methods of calculation.
- Expertise – Contract loading and government programs experts who integrate with all PAS and Claims Management functions.
- Efficiency – User-friendly reporting, trending across payors and multi-facilities.
- Foresight – Powerful modeling to protect future revenue.
- Results – 5-10x ROI based on historical performance.
With nThrive, you can leverage the power of data to position your organization for success, even when the unexpected occurs.
Learn more about our industry-leading Contract Management solutions and how your hospital or healthcare organization can minimize payment variances while improving revenue cycle management success. Contact nThrive.