How to Better Manage Healthcare Payer Contracts

How to Better Manage Healthcare Payer Contracts

Healthcare payer contracts need to be monitored and managed in the right way to ensure the smooth running of a healthcare organization. They outline how healthcare providers are paid when they provide certain types of patient service when under a particular health plan. They will mainly outline reimbursement rates and include medical necessity, credentialing, and provider network.

Keeping up with these kinds of agreements can be challenging. Specifically, a lot of time may need to be invested in learning important contract details or terms. As a result, deadlines can be missed for the filing of claims. Or, conditions surrounding quick reimbursement might not have been met. For providers, this can mean that they may not receive all reimbursement payments properly, or incorrectly calculate revenue streams that can affect your bottom line.

Payer contracts need to be understandable for all practice and hospital administrators so that the organization in question is paid for services given. Here are some of the best ways to manage healthcare payer contracts.

 

Organize and Store Payer Contracts with Contract Management Software

Payer contracts can all be stored in the same place thanks to contract management software. No longer will staff have to trawl through shared drives every time they need to include a specific contract.

Equally, manual and labour-intensive methods like tracking contracts using a spreadsheet or storing them on shared drives, can cause errors and waste time. When multiple people are all working from the same spreadsheet, things can get even more complicated.

 

Understanding Complex Contract Language

In order to understand challenging clauses or common requirements, it’s necessary to understand the language used in agreements, particularly for the person who manages the payer contracts within your company. In particular, ensure this person fully understands clauses surrounding things like reimbursement policies, network requirements and unilateral amendments. Not understanding how they work can result in payers actually changing agreements, without the provider even knowing.

 

Conduct Reports for Important Details or Terms

Knowing all the different provisions of your contracts is essential for managing them properly. Understanding the basics, like reimbursement guidelines and rates, can also include other things, like how long the payer has to reimburse the provider after a service is provided, how long a provider has to submit a claim, or requirements surrounding renegotiation and termination. Tagging this kind of information is possible in many types of contract management platforms, which also allow the creation of reports so that users can see variation across other contracts as well.

 

Ensure you’re Always Aware of Termination or Renegotiation Dates

With healthcare payer contracts, it’s usually the payer themselves who has the upper hand. Nevertheless, you can take back some control by working out if you need to make any changes to agreements. You might even decide to terminate the contract with the payer entirely.

Get ahead of key notifications and alerts by using this inbuilt functionality of the software to inform you way in advance of any upcoming dates. The user can set the time frame by which they want to receive notifications, giving them time to work out what they need to do for each agreement so that they can take the best next steps possible.

 

Set Agreements on Your Terms

Providers can use reporting functionality to look closer into their contracts, from the perspective of both performance and content. Using this information, you can then discover potentially better reimbursement rates by working closely with payers. You may even decide to find new payers if that works better in your favour. The fact that all responses are evidence-based and data-driven means that the terms and contracts you’re able to renegotiate will be more favourable to your business.

 

Healthcare Payer Contracts on Your Terms

It’s common for most healthcare providers to work with both government and commercial payers with regards to their agreements. Therefore, trying to determine the structure of every single contract may seem unfeasible. The truth is that the entire contracting process can be optimized using contract management software. In your contract portfolio, you’ll be able to see all the critical information, then, take whichever action you deem necessary to achieve great results for your company.