- Reimbursement Issues (denials, late payments, incorrect payments, inaccurate information)
- Expanded insurance coverage provisions through the Affordable Care Act (ACA)
- Data collection for meaningful use and reimbursement incentives
- Expanded credentialing requirements create a new and more complex environment for providers and healthcare facilities
Reimbursement models are changing and Payer Relationship Management (PRM) is more important than ever!
- A strategic approach to understanding and cultivating payer relationships is the key to success. They need you and you need them!
- Understanding your own data will assist in cultivating financially positive relationships – knowledge is power!
Take control of your Payer Relationships!
PRM supports your providers, practices and facilities to capture, store, monitor, track and leverage all information related to the billing and reimbursement processes. This information includes detailed and up-to-date provider profiles (credentialing), practice profiles (leverage), payer profiles (market research), reimbursement activities (proper payments), and patient care activities and efforts (data collection).
PRM is the lifeline of your practice and facility—
—and requires expertise, knowledge, and a multidisciplinary approach of professionals who understand and stay ahead of the changing healthcare environment and requirements. Every practice and facility should focus on PRM to maximize revenue by:
- Incorporating tools and systems to report and understand your practice’s financial health, financial needs, and patient care data
- Understanding the current relationship with reimbursement sources (i.e. payers), including language, rates, etc.
- Understanding your market, your competition, and most importantly your value!
- Identifying opportunities to increase reimbursement (leverage)
- Verifying all provider and contract information is loaded correctly in payer systems to ensure proper and timely payments (credentialing)
- Understanding new reimbursement models to obtain additional payments (i.e. incentive payments), and avoid penalties that will decrease revenue
- Ensuring efficient reimbursement processes to maximize cash flow (i.e. EFT, ERA)