Holding Payors Accountable

By ACE Auditor: Donna Schlemmer

The most effective way to hold payors accountable begins with letting technology work for you. Most software programs can load fee schedules for each of your contracts. This should be done at a minimum for the top 5 payors. The software program should be sophisticated enough to handle the specific details of the contract such as the ability to calculate time units and whether the payor allows payment for physical status and qualifying circumstances.

ACE has a few quick tips in dealing with Managed Care Contracting:

1.  Don’t Limit Your Focus to Rates — The key is to negotiate each part of the contract and not get too focused on just rates.
2. Create a Profile for Each Managed Care Contract Prior to Negotiating – Understanding what you are getting now is key if you are to know whether you are improving your position in a positive way.
3. Know Your Payor and Your Contract – Just as important is to know how much business this represents and what are the “pain” points in dealing with this carrier.
4. Apply as Much Leverage as Possible — Assess your practice’s leverage points and what you have to offer.
5. Be Ready to Compromise — Compromises are a necessity in negotiation and each party should be prepared to give to get.

ACE has been in the billing, coding, and managed care evaluation business for a very long time.  Our auditors have expertise in organizing your information and compiling data to help you understand where you are and what you need to get to your true goals.  If you would like help with any of the steps above, give us a call!