How to Improve Payer-Provider Relations
If you’re looking to make your practice’s cash flow more predictable, your dealings with your payers are the place to start. If you cultivate fruitful relationships with the most common insurers in your patient base, you’ll likely see fewer denials, higher reimbursements, and a smoother revenue cycle altogether.
There are a lot of common sense ways to make interacting with payer reps less stressful – the top one of them being to train your staff to be patient and courteous when resolving issues over the phone. But improving payer-provider relations at a more fundamental level requires a commitment from your practice to doing back-office business the right way. Here are our top tips to help make your payers more like partners than adversaries.
Review Your Contracts
From the very start, your contracts with payers lay the groundwork for how successful your relationships with them will be. If you sign off on them without thoughtful review and consideration, or if you let your contracts renew year after year without negotiating new terms, you’re selling your practice short.
Whenever entering into a new relationship with a payer, spend time carefully assessing the rules of the contract and considering the ramifications of the terms and clauses. (Don’t hesitate to consult a third party if you’re new to this.) Make sure the contracted reimbursement rates are competitive with other payers in your community. Don’t forget to note your renewal date and to watch out for ‘evergreen’ clauses, which can cause your contract to automatically renew unless you notify the payer otherwise.
Establish Contacts
During the beginning of the payer relationship and the contract-signing phase, a practice manager typically has a go-to contact at the new payer organization to guide them through the initial stages. That person may still be accessible if you want to renegotiate terms, but the rest of your team – especially your billers – are likely stuck with simply an 800 number.
That anonymity can create problems. Who should your staffers contact if they get terrible service from the payer? What happens if the payer’s team makes a big mistake? Make sure that each of your payers gives a direct contact to reach out to in the event of an issue.
Improve Your Processes
It’s easy to complain that your payers are the problem… but are they? If your back office is not a well-oiled machine, you can’t expect perfection from your payers.
Revisit your policies and procedures to see if there are gaps in your process. Is anyone double-checking your coders’ work for errors? Are you properly scrubbing claims before submittal? Is there a common specification of a picky payer that you’re not meeting? Make sure your billing department is a tight ship… or…
Lessen Your Burden
Consider how outsourcing medical billing can resolve your payer concerns. Medical billing services have longstanding relationships with major payers and have the knowledge, staff, and resources to quickly, efficiently, and effectively get your practice paid.
Contracting with a medical billing company can lower your administrative burden, increase your reimbursements (through lowered denial rates), and free up your staff’s time and energy to focus more clearly on patients. Find out more about lessening the hassle of working with payers.
Find out more about medical billing? Check out our Blog
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