Managed Care Revenue Cycle Strategies are Critical to Increasing Payer Yield

If financial health and sustainability are to be ensured for community hospitals, it is prudent that they maximize reimbursement while also improving payer yield. 

Hospitals have to pay a lot of attention to control costs so that declining reimbursements can be dealt with effectively. 

However, they might still have to face lower payer yields than they expect if a coordinated managed care is not implemented. 

A Midwestern community hospital that required improvement in financial returns decided that the time has come to analyze how to handle contracts with the payers. It was reported that there was a drastic difference in what the provider should receive as per the contract and what it was actually getting.

Various factors can be considered responsible for this. Lack of education and awareness among the staff is a significant factor. 

If there is one thing that needs to be made clear to the team, it is that the payer is not always right. If the payer states that the payment is here, it does not necessarily have to be true.

Once the staff is clear about how to collect the money and validate the payments, negotiations will become a whole lot easier.

If there is a significant gap in what the hospital is getting and should get, the administration needs to wonder if the billing is being done correctly. 

The facility needs to focus on the payment process behind the scenes so that it can acquire a better understanding of what needs to be done during negotiations.

The first thing the hospital did was to make sure that the billing was done correctly. 

A close check was kept on all the claims coming back. A briefing was given to the patient financial services department as to what they needed to focus on.

It was equally vital that a check was kept on where patterns emerged. 

For instance, if the hospital billed for something that the payer did not pay for or paid less, the cause needed to be determined.

The role of negotiations

The team realized the indicators that could come in handy if they wanted to get paid adequately. 

This is vital in all situations. 

A lot of hospitals do not have the budget to get a full-time managed care staff on board. 

Thus, they usually avail the assistance of a financial services team, given their level of expertise and experience is limited, problems arise. 

However, all this does not imply that hospitals start regarding payers as their foe. 

Instead, they need to focus on working together. A payer-provider union can make a world of difference. Cases should be taken to the negotiation table so that all the pieces fall in their right places. 

It is essential that the hospitals are honest with their payers. An open dialogue with the payer can change things for the better. 

The key is educating the team so that they can notice the patterns and address the issues accordingly. 

It is vital that all community hospitals adopt a proactive approach so that they can handle their payers’ contracts effectively.

Learn how our AllPayor® Software is saving other organizations $$MILLIONS!

If you are interested in a free demo of our AllPayor® Software, please go HERE or you can register for a FREE webinar HERE