By all accounts, healthcare reimbursement is complex. Given the highly specific contract terms between thousands of providers and payers, there are bound to be situations where payer compliance falters and payments are not accurate. In fact, national payers make approximately 500 payer policy changes a year, which only adds to the complexity. As organizations strive to manage multiple payer contracts, varying reimbursement models and emerging care delivery approaches such as accountable care organizations (ACOs), there’s a greater likelihood of payer underpayments.
While the tune remains the same, identifying opportunities to refine payer accuracy continues to be critical to improving revenue in light of declining reimbursement and increasing bad debt. The difference, however, is that by leveraging data and analytics to verify payer compliance with contract terms, healthcare organizations are empowered to proactively minimize risk and increase revenue, while making a traditionally complex process much simpler.
Payer underpayments can be a costly problem for organizations. Not only do they reduce the income into an organization, they can also lead to inefficient claims auditing as well as higher billing and contract administration costs. Data and analytics can help confirm contract conditions and payment accuracy so that hospitals can ensure full reimbursement while also reducing invalid denials.
A data-driven approach to contract management also allows hospitals to precisely value the claims according to the most current contract terms, pinpoint sources of recurring errors and evaluate contract performance. This strategic approach uses data to proactively adjudicate claims on a daily basis, enabling hospitals to get a more accurate representation of accounts receivable.
The nature of healthcare reimbursement is only going to get more complex, leaving no room for questions about payer payment accuracy. Find out how Experian Healthcare Contract Management for hospitals can help you improve payer contract performance and enhance your revenue cycle management.