Hayes' Healthcare Blog

Margaret Webb-Nolan

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11 Ways to Make Sure Your Contract Management Process is Meeting Your Organization’s Needs

Posted by Margaret Webb-Nolan on April 5, 2018 at 9:00 AM

Managed care contracts make up a significant amount of a healthcare organization’s revenue stream.  The impact these contracts can have on your top and bottom lines makes managing them appropriately one of your top priorities. Those organizations that have realized this and have an effective, efficient contract management process in place have a reasonable upper hand over those that don’t.

Staying on top of your managed care contracts is critical to maintaining a sound financial foundation. Managing these contracts successfully can help drive additional revenue through new insurance products. Properly handled managed care contracts can also increase patient satisfaction by enabling patients to obtain the treatment they need.

If you have challenges in keeping track of and managing your contracts, you are not alone; it is an all too common problem in hospitals and healthcare organizations across the county.

Here are 11 things to consider that can help you develop and administer a successful contract management process.

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Topics: Contract Management, Revenue, Managed Care Contracts

Reimbursement Analysis – A Critical Component to the Implementation of New Services

Posted by Margaret Webb-Nolan on August 16, 2017 at 9:00 AM

In our current competitive healthcare environment, innovative services are an important dynamic to a successful revenue cycle.  Patients want the most current care delivery methods, new technology, pharmaceuticals, and actively seek providers who can supply them. 

Thorough reimbursement analysis which provides an accurate picture of the reimbursement environment as it pertains to your new service is important to ensure your organization will be able to provide new, innovative services like newly released drugs, devices, and implants to patients while still achieving a margin which will allow continued growth.

A comprehensive reimbursement analysis should be conducted with adequate lead time to include an in-depth understanding of payer-mix, the delivery cost of the new service, and the anticipated reimbursement by the designated payer.  Also included should be detailed coding and billing requirements to ensure your organization is prepared before service delivery to process claims.

Those of us who are healthcare professionals have probably been in situations where new services are initiated without the inclusion of the appropriate revenue cycle team members, resulting in denials, delays, loss of revenue, unhappy patients and discontent providers. Multiple departments should be included to ensure a comprehensive approach is conducted.  The service area, coders, reimbursement, billing, and a CDM resource should all be included.  If the new service is a new drug, an appropriate pharmacy resource should be included, as well.

To avoid the need to recover lost revenue and implement service backfill, it’s crucial to have a structured program in place. This program should include a check list and appropriate sign-off from all pertinent staff or departments involved.

Here are the critical components to a successful reimbursement analysis. To spearhead this initiative, many organizations have a reimbursement analyst on staff and others may utilize a CDM resource for managing this activity.

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Topics: revenue cycle management

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