Best Practices For Healthcare Contract Management To Validate Reimbursement Accuracy

Healthcare Contract Management

Hospital management and healthcare providers are trying to look for ways to minimize the costs without affecting medical care management. Contract management in healthcare is the one facet that is often overlooked.

Every year, many US healthcare companies and medical facilities sign contracts with a variety of insurance agencies. Each payer has distinctive standards, policies, regulations, and parameters to follow.

Moreover, the US healthcare industry is observing various new reforms like the implementation of the ICD-10 code set. So, it is an enormous task to keep track of all the contracts in this challenging environment. 

Healthcare providers must consider hiring efficient medical billing companies to combat these difficulties. That’s the only way providers can get paid according to the care agreement management.  

Experienced medical billing professionals help you to streamline the healthcare contract and policy management processes. They can play a critical role in tipping the scales in the favor of providers. 

However, what are the best practices a provider needs to be aware of contract management in healthcare? To learn about this. Let’s dig deep into the topic:

What is Healthcare Contract Management?

It is a traditional agreement that takes place between a consenting group of two parties. In healthcare usually between a healthcare provider or a physician, health maintenance organization, different health care plan, integrated delivery system, or an MCO (managed care organization) like a provider-sponsored network. 

Aside from this, these contracts can be established between providers and vendors, employees, and more. They are focused on the requirements and responsibilities of each group to comply with federal or state laws. 

Healthcare facilities connect with many insurance agencies for tending their patients of different insurance policies to the specific payers. 

Time is indeed money in this fast-paced competitive industry. Thereby, many providers overlook the vital clauses affecting the contracts and entirely focus on patient care. 

A medical practitioner can face delayed payment if factors like covered benefits, service issues, incentives, are not properly managed. 

Contract Types:

  • Technology licensing.
  • Physician recruitment contract.
  • Physician employment contract.
  • Purchased services agreements.
  • Transfer agreements.
  • Medical records and patient agreements.
  • Supervision agreements.
  • Partnerships with other medical organizations.

Best Healthcare Contract Management Practices

What does it mean by best practice in healthcare? It is maximizing efficiencies without sacrificing quality patient care. So, what should be the best practices when it comes to payor contracting and contract management in healthcare?

Standardize Contract Processes:

It is highly integral that you should form a defined process for each contract type and every agreement. This can enable you to create additional efficiencies and ensure compliance. 

Basically, the stages in the contract procedure are:

  • Initial request.
  • Review the agreement. 
  • Make corrections.
  • Approve.
  • Final document storage.

Renewing and establishing a contract in healthcare is quite complicated. Because it requires many individuals for submission, correction, approval, and signing documents. Which builds a lot of space for errors or delays. 

Therefore, you can streamline your practice to help save time/money and prevent mistakes by standardizing the processes.

Utilize a Contract Management System:

Within a healthcare organization, the majority of transactions are subject to contracts. It can put a significant impact on your bottom line and daily business operations.

However, many providers rely on manual systems despite many issues they face. According to a black book study of 2019:

“96% of provider organizations and the US health systems participating stated they are using manual processes. As they either have a system that is outdated or not have a contract management system. And it is inadequate to address value-based care.”

Moreover, the manual procedures maximize your costs, reduce your reimbursements, and increase risk. Providers must have a system that facilitates the transition to a fee-for-value model from a fee-for-service, and aids:

  • Improve payment accuracy.
  • Minimize contract risk.
  • Develop payor contracts. 
  • Maximum reimbursements. 
  • Improve negotiating managed care contracts.
  • Audit tracking and reporting.

Optimize Security:

Compliance is mandatory to secure your sensitive data from abusing and misusing. A medical practice must ensure compliance with HIPAA standards. These privacy guidelines and federal regulations help you to comply with privacy protocols. 

You can face significant harm to your bottom line & reputation if you do not comply with privacy protocols. You link each contact to the relevant security regulations by an effective contract management system. This will help you to create company-wide, seamless, and compliance integration. 

Take Assistance of Professionals:

New government mandates/directives, technological disruptions have made the healthcare industry more challenging. Healthcare providers have to stay compliant with these changes on the fly. 

Complicating factors like the demand for heightened security and compliance regulations – have forced the practice management to adapt to these disruptions. 

Many medical facilities are taking advantage of contract management specialists. As they need to reflect the most current laws and regulations. 

Significance Of a Professional Medical Billing Company:

  1. An outsourced medical billing agency checks if the payer pays as per the contract. And helps you identify the top payers of the healthcare facility/providers. 
  2. Expert billing professionals keep an eye on what is changed and what doesn’t. And conduct a thorough analysis of the payers’ contracts. 
  3. The company maintains and creates a database to handle contracts in healthcare management. The database indicates the fee schedules and policies of various payers. 
  4. Medical billing agencies can easily track payments by utilizing this database. In addition to this, they can analyze which insurance companies didn’t pay. And finalize the next steps to get the proper reimbursements. 
  5. Billing experts outline risk mitigations and procedural details. While providing unlimited templates during the re-credentialing of the healthcare contract and policy management procedure. 

Key Takeaway:

You can leverage actionable data and gauge relationships by parenting with contract management specialists. Dedicated medical billing teams provide all the tools, techniques, relevant data, and proper visibility to the right contracts. 

You become able to map out the most effective relationship path to validate reimbursement accuracy. And you can capture every major aspect of payer contract interaction to achieve the results your organization demands.  

With a trusted partner, your team can adhere to best practices across the optimization of contracts in three main phases – identifying potential opportunities, reviewing current contracts,  and renegotiating with payers – to help maximize reimbursements. 

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