MEDHOST Blue Logo

Let’s talk about your EHR needs: 1.800.383.6278  

Nearly 50 percent of rural hospitals in our country are operating in the red, with over 450 at risk of closure. As hospitals face regulatory and market pressures, they are focusing on areas that can have an immediate positive impact on cash flow, such as revenue cycle management (RCM).

In this blog, we explore some of the pain points in RCM related to contract management, and how to resolve them.

What is Contract Management?

Hospital contract management is the process of overseeing and optimizing agreements between a healthcare organization and various stakeholders. It often involves negotiations with insurance payors, labor representatives, vendors, Group Purchasing Organizations (GPOs), and contractors.

The process of contract management includes negotiations, creation, implementation, monitoring, and maintenance of these contracts to ensure financial viability, efficiency, and compliance.

Managing this process can be complex and time-consuming. When organizations are experiencing staffing shortages, or operate with a smaller team, it can be easy to let contracts re-up without review, put maintenance on the back burner, and neglect other important aspects of the contract management process.

How Does Contract Management Impact the Bottom Line?

Effective contract management is essential for healthcare organizations to establish financially beneficial relationships with their stakeholders. Well-maintained and expertly negotiated agreements help ensure that organizations receive appropriate reimbursement for services, helps maintains good relationships with partner organizations, prevents unnecessary legal risks, and supports overall financial stability. Unfortunately, providers spend approximately $157 billion annually on less-than-optimal contract management.

Maximizing reimbursement should be a well-governed, ongoing pursuit. Established steps, including workflow automation, a centralized document repository with audit tracking, linking to regulatory and policy documents, and proper representation in the development team can help to cut down on these costs while simultaneously ensuring more revenue is flowing back into the facility.

What Can Hospitals Do to Optimize Contract Management?

Conventional wisdom states that “a contract will perform as well as you let it.”

A hospital may believe they have negotiated a fine contract, but without an effective means of payor and contract monitoring, it can be a challenge to know if that’s really the case. A contract may be performing particularly well for a period and then start realizing occurrences of specific types of denials, down-coding, or underpayments. At an average cost of $118 per appeal, this can be a significant drain on resources.

Effective analytics and performance monitoring can provide critical insight to prevent denials, including:

A transparent approach should also allow you to see underpayment variance trends, understand insurance payor agreements, and anticipate where issues may arise in the future.

MEDTEAM Contract Management

MEDTEAM supports healthcare organizations in negotiating, building, updating, and maintaining contracts that include favorable rates and terms. Moreover, they provide payment variance analysis and recovery services, meticulously identifying reimbursement variations and collaborating with clients to pinpoint underlying causes. This strategic approach ensures that no revenue opportunities are left untapped.

To learn more about how MEDTEAM supports effective contract management, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

MEDHOST first engaged with Amazon Web Services (AWS) in 2013 to facilitate a cloud-based patient portal. Since then, we have expanded this collaboration to include the development of better interoperability solutions, enhanced clinical capabilities, and access to meaningful analytics.

As part of the AWS Partner Network (APN), this ongoing dialogue provides us with the necessary tools to create and deploy new products while enhancing existing customer solutions. In this post, we discuss our history with AWS, current initiatives, and projects still on the horizon.

CURES Act

As a leader in the Healthcare IT (HIT) space, our mission is to help providers achieve interoperability, or the secure and easy exchange of electronic health information (EHI).

Seeking to protect and define interoperability, congress signed the 21st Century Cures Act into law on December 13, 2016. The Cures Act established an actionable legal framework that required hospitals to give patients and their providers secure access to all healthcare information stored in electronic health records (EHR) and other health information technology (HIT) systems.

More importantly, the Cures Act prohibited all practices that interfere with collecting, sharing, and using EHI within an appropriate care setting, commonly known as health information blocking.

API Support

As part of the Cures Act, compliant EHRs were also required to provide data through application programming interfaces (API), allowing programmers to use third-party resources to create interoperability software geared toward providers and patients.

Moreover, APIs must comply with Fast Healthcare Interoperability Resources (FHIR) standards for exchanging healthcare information. FHIR API interface standards ensure that patients own their data and can access it in real-time. While this benefits the patient directly, it also allows providers to adopt emergent technologies, such as mobile applications, that increase ease of use.

Multi-Tenancy

Using AWS FHIR Works, Amazon’s open-source programming toolkit for creating multi-tenant, interoperability solutions, we worked with AWS to build an API platform that could be universally implemented at our partner hospitals.

Multitenancy is a software architecture that allows a program to run on a single server, accessible by many clients. For MEDHOST customers, many of which operate in remote or rural settings, independently setting up and managing an FHIR server is a daunting challenge. By offloading FHIR API to our servers, these customers can simplify compliance, enhance security, and minimize disruptions.

The MEDHOST Cures 2023 Interoperability Solution incorporates all the functionality mentioned above into a single, comprehensive deliverable. This solution creates a framework for the seamless and secure access, exchange, and use of electronic health information for healthcare systems of any size, anywhere.

Mobile Solutions

As part of MEDHOST’s commitment to providing industry-leading, affordable technology to rural and community hospitals, we conduct regular advisory group sessions that help facilitate a dialogue between our engineers and customers. These sessions allow us to understand the unique challenges these facilities face and better catalog their workflows and processes.

Developed in collaboration with AWS, and with insights gleaned from our customers, we created MEDHOST Mobility Physician, a mobile solution that empowers providers by putting EHR insights in the palm of their hand.

Instant messaging was a particularly exciting capability that stemmed from these sessions. Through Amazon Chime SDK, which facilitates real-time communications for web or mobile applications, providers can place orders and receive critical notifications within the MEDHOST Mobility Physician app.

In the future, we plan to augment this solution with machine learning-powered data visualizations and intelligent tools that allow physicians to better predict patient outcomes.

Analytics

When MEDHOST first began working with AWS to enable Cures Act compliance, it became apparent that artificial intelligence could be leveraged to extract advanced analytics, opening the door to better insights from secure clinical data, such as vitals, diagnoses, medications and procedures.

After collaborating with the AWS Data Lab team, our engineers quickly identified the importance of data lake, and built a platform to deliver analytics to hospitals as software as service (SaaS).

Data available in the cloud can provide radical solutions for some of clinicians’ most pressing concerns, like predicting the onset of sepsis and cardiac risk.

In addition, by utilizing the AWS QuickSight business intelligence tool, MEDHOST YourCare Analytics brings these advanced insights to the hospital back office, making it easy to target and track the most critical data related to effective contract management, projections, postings, denials, and overall business growth.

To learn more about how MEDHOST’s AWS-powered solutions can benefit your hospital, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

The regulatory views and assessments contained within this post are solely those of MEDHOST.

Healthcare analytics is a growing field, spurred on by the need to stay ahead in tightening markets, keep pace with regulatory compliance, and harness technological innovations that demand greater and greater precision in health management.

By combining the expertise of business service professionals with robust analytical tools, like cloud-based software and smart contract management insights, hospitals can drive exceptional revenue cycle performance and improved patient outcomes.

Intelligent Business Services

At many rural facilities, workforce shortages and increased patient volumes often mean that process evaluation, account follow-up, and ongoing reporting are either scarce or nonexistent.

Without access to comprehensive business service analytics, it’s nearly impossible to point to current return on investment (ROI) conditions and create actionable strategies. MEDHOST YourCare Analytics™ functions as part of our expanded business services offerings, letting providers know where improvements have happened and where they still need to be made.

Contract Management

Hospitals spend billions on contract management every year, often using outdated processes. But without data-driven payor and contract analysis, negotiations may be leaving money on the table.

For instance, without the proper insights to guide renewals, a contract that has been performing well might become a source of denials, down-coding, or underpayments.

Critical business data that MEDHOST uses to optimize contract management includes:

Cloud-Based Solutions

Powered by the Amazon Web Services (AWS) cloud platform and its QuickSight business intelligence tools, MEDHOST YourCare Analytics gives customers valuable insights into the most critical data for their business growth and continued success.

As a part of the Amazon Partner Network (APN), MEDHOST’s innovation and development teams work closely with AWS experts to create and deploy new capabilities and enhance existing solutions.

Multi-tenant, cloud-based analytics solutions also open the door for future advancements in business analytics, including the implementation of machine learning to improve patient throughput, contract management augmented by artificial intelligence (AI), and more consumer-centric mobile applications.

To learn more about how MEDHOST can help establish actionable metrics and analytics, please reach out to us at inquiries@medhost.com or call 1.800.383.6278

Since becoming effective in January 2021, healthcare providers have, by and large, failed to embrace the Centers for Medicare and Medicaid Services’ (CMS) price transparency rules. But now that CMS is seeking to levy hefty fines for noncompliance, rural hospitals are in a unique position to benefit from competitive prices and improved digital engagement.  

What Are CMS Price Transparency Rules?  

To be in good standing, providers must compile vast amounts of billing data and post this information online, including a machine-readable file of all standard charges and a consumer-friendly list of 300 shoppable items and services.  

Shoppable services include non-emergency care that may vary in price depending on the provider. If a patient needs an MRI, for instance, and they have four facilities in their area, they would be able to visit each facility’s website and see the cost for that procedure based on their insurance payer. 

According to the most recent JAMA analysis, however, approximately 51 percent of hospitals do not adhere to these specifications.  

Why the Hesitancy?  

Complying with these rules isn’t as easy as it sounds.  

To begin, hospitals must cull and maintain a great deal of information. For each chargeable item, compliant facilities are required to list gross charges, each payor’s contracted price, a discounted cash price, and a de-identified minimum and maximum negotiated price, while ensuring these numbers are updated annually.  

Next, compliance can represent a serious financial liability for providers. Potential consequences of up-front pricing include jeopardizing payer contracts, exposing competitive weakness in a tight market, and demanding intensive admin work from already understaffed back offices. 

Finally, with the healthcare industry still excavating itself from the effects of the pandemic, CMS was reluctant to enforce the proposed penalty of $300 a day against hospitals that ignore or fail to satisfy requests for corrective action.  

CMS Ups the Ante  

CMS sent shockwaves through the healthcare industry earlier this month when it levied fines for the first time against two Georgia hospitals: Northside Hospital Cherokee and Northside Hospital Atlanta. With a combined price tag of over $1 million, these penalties sent a clear message that the government will take an aggressive stance on enforcement moving forward. 

Accordingly, CMS will audit hospital websites and evaluate complaints made by individuals to determine whether these facilities are in good standing. For providers that do not comply, they will issue a warning notice, request corrective action, then impose a civil monetary penalty and publicize the infraction on their website 

While this may come as an unwelcome wake-up call for big providers who have been dragging their feet on compliance, the scramble to meet federal policies represents a rare opportunity for rural hospitals to cash in on improved positioning.  

The Rural Hospital Advantage 

Competitive Pricing 

Facilities in unconcentrated healthcare markets often have lower prices than their urban counterparts. 

Getting these competitive prices out front, especially during a tough economy, may make otherwise overlooked healthcare destinations more attractive to those seeking treatment.  

A trusted partner in healthcare IT can help facilities continuously engage with consumers, build their brand, and increase revenue through an expanded digital strategy. 

Increased Revenue 

The revenue that comes with an expanded customer base can present a welcome respite for remote facilities that have been struggling for years to operate in the black 

Adopting technology-driven price estimation and contract management services and solutions can not only help smaller practices by providing patients with more accurate financial expectations up front, it can also ensure that facilities are reimbursed correctly from payers after care is complete.  

Improved Digital Patient Experience 

Empowering patients with online price expectations improves customer satisfaction. But furnishing accurate price estimates on a hospital’s website, and at registration, is only part of the opportunity for engagement.  

By implementing a comprehensive digital patient experience, hospitals can provide anywhere-access eStatements, online bill pay, telehealth options, and the flexibility of digital support that modern consumers expect. 

MEDHOST’s Price Transparency Solution 

The MEDHOST Price Transparency Solution can help hospitals put accurate and up-to-date pricing in front of new customers, leverage the latest digital tools to improve patient care, and increase the flow of revenue. Our offerings include:  

It’s time rural hospitals had the edge. We’re here to help. To learn more, contact us at inquiries@medhost.com or call 1.800.383.6278.  

A survey by Black Book Market Research estimated that healthcare organizations spend $157 billion on manual contract management each year. In the same study, almost all of the respondents (96%) reported using an outdated or completely manual process. This presents healthcare facilities with an ideal opportunity for revenue cycle optimization through adapted insurance contract management.

But while larger provider organizations might have access to bullpens of sourcing experts, teams of industry-savvy negotiators, and custom-tailored contract management software, it may come down to two or three individuals working to provide the same value and quality of patient care on a shoestring budget in the front offices of smaller, community hospitals.

MEDHOST Revenue Cycle Management empowers your business office services by becoming an extension of your existing team. Our experts truly understand the challenges our clients face in an ever-changing healthcare environment. Comprised of patient financial and health information management professionals, we can supplement your hospital's business office services team, assisting with everything from billing to cash posting to effective contract management and account follow-up.

Here are five ways the MEDHOST Contract Management solution supports your business office services:

The Contract Management Process

Contract Creation and Maintenance

Our Contract Management team will build and maintain expertly negotiated payer contract terms within MEDHOST Enterprise Solutions as well as provide ongoing maintenance.

Once the insurance contracts are built and attached to the correct plans within the enterprise system, the identification and recovery of insurance underpayments, as well as overpayments, can begin.

Underpayment Identification

This is revenue that you might not even realize is missing, and it can amount to thousands or even tens of thousands of dollars every month.

Our Contract Management team will identify and address trends in billing errors and systemic insurance payor issues via variance reports, then notify you of any issues hindering the accurate calculation of expected reimbursement.

Underpayment Recovery

During this step, MEDHOST will work alongside you to collect unpaid reimbursements from insurance companies.

Over the last year, we collaborated with our community hospitals to identify and recover over $4.9 million in revenue that was either not paid, or underpaid.

Overpayment Recovery

Months or even years after an insurance company overpays, they may ask for that money back. In some instances, they will automatically withhold the amount from current payments, creating a sudden disruption of revenue.

We can help you to be prepared by identifying overpaid claims before they become a problem.

Transparency

Our Contract Management team will have a bird’s eye view that allows them to identify the root cause of insurance underpayment or denials and the actions taken to recover missing revenue.

We will communicate this information to your team and work with you to identify underpayment variance trends, understand insurance policies, and anticipate where issues may arise in the future.

MEDHOST Revenue Cycle Management

Facilitate accurate reimbursements through automated contract lifecycle management, calculate and reconcile expected payments for more effective communications with the insurance carrier, save time and reduce risk.

To learn more about how MEDHOST can support contract management, contact us at 1.800.383.6278 or email inquiries@medhost.com.

From a minor check-up to major surgery, the lifecycle of a healthcare claim can be full of complexity. Complexity means mistakes are more likely to occur. Preventing errors in the claims process is the best way to ensure hospitals receive accurate payments on time and patients have a positive billing experience.

With so much pressure to capture revenue quickly, hospitals sometimes miss needed attention to detail to ensure an error-free claim. Forcing error-ridden claims through a revenue cycle management (RCM) process often results in further delays. The struggle to retain skilled front office staff can also create additional challenges in achieving prompt, complete reimbursements.

By outlining how MEDHOST Business Services helps work in healthcare, we illustrate how supplementing the RCM process with additional expertise can advance a claim's lifecycle, supporting a hospital's overall financial health.

A Healthcare Claim is Born

After patient discharge, the associated account goes through a pre-bill edit process directly within the MEDHOST system. This process generates errors on a Bill Selection Error Report (BSER), which the hospital should work on daily.

Using the BSER as a point of reference and once bill hold 'suspense' days are met, a claim is born. Having the support of a third party in this early stage can be one of the most critical steps to creating a clean claim.

Claim Arrives at the Clearinghouse

Every morning MEDHOST generates an (EDI) 837 file of accounts selected for billing. This file is then automatically transmitted to a facility's clearinghouse, removing the need for any manual processing by a hospital's team.

At the clearinghouse, another round of rigorous error checks takes place, including any payor-specific edits. Claims that are error-free enter a valid state. The clearinghouse then sends those valid claims to the payor for adjudication. If errors do exist, the clearinghouse works them for clean claim submission.

Working Claims with Errors

A clearinghouse may reject a claim for various reasons, such as invalid patient policy information, incorrect insured relationship, other insurance as primary, and physician credentialing.

Hospitals can reduce most of these rejections by defining an eligibility process that occurs upfront before admission. If such an approach does not exist, the MEDHOST Business Office Services team can help define one.

Claims with reported errors go back to MEDHOST for review by one of our qualified billers. Reviewers apply corrections and place the claim in a valid state. MEDHOST works most rejections within 72 hours of reception.

A Claim at the Payor

Once a payor receives a valid claim, they determine whether to pay or deny the claim during the adjudication process. There are instances where partial payment and partial denial occur.

At this stage of the process, if a hospital utilizes MEDHOST Contract Management, we help determine any expected reimbursement variances using a module that integrates with a hospital's financials.

When payments post, the expected and actual reimbursements go through a review. Any accounts with variances show up on a report. This same process occurs with denials.

This entire process removes much of the burden of contract management from a hospital's business office and helps ensure accurate reimbursements.

Underpayment and Denial Management

The MEDHOST Business Services Denial Management team works every variance in a claim to determine underpayment. Where applicable, MEDHSOT will initiate an appeals process with individual payors.

In addition to appeals, the MEDHOST Business Services team will also follow up with payors on outstanding accounts receivables. This process determines if an account needs rebilling, adjustments, or is the patient's responsibility.

Automation plays an essential role in MEDHOST's day-to-day account management, helping steer the lifecycle of a claim forward with minimal manual intervention.

Accelerate Your Claims and Revenue Cycle

MEDHOST Business Services can help nurture the lifecycle of a claim and make sure it results in total payments. Comprised of patient financial and health information management professionals, we can supplement your hospital's front office team and revenue cycle management process from billing to cash posting to contract management and account follow-up.

To learn more about how we can help you streamline the life cycle of claims and collect the most accurate payments from payors consistently, reach out to us at inquiries@medhost.com or call 1.800.383.6278.

 

In the last entry of our three-part series on revenue cycle management we will be talking about best practices in resolving denials.

When considering this topic your first thought might be “every facility has different rules regarding denials.” And while contracts, payor mix, case mix, local coverage determinations, and staffing are all factors in determining what types of denials your facility might pursue, we will examine this topic from a higher level “best practices” approach.

Our examination looks at methods that should be practical in most every facility. High performance in appeals processing is important as studies show that 24 percent of denials cannot be recovered. Given that statistic, the value of a sound appeals processes in appealing the remaining 76 percent cannot be understated.[1]

Business Rules

Establishing a clear set of business rules is a critical first step in process definition.

Having rules that clearly define what sets of appeals your team will or will not pursue will assist you in bucketing appeals appropriately.

Cost Analysis

Every week that passes with an account in receivable hurts your bottom line. Your best practice may be to age denials for a period in order to settle remit activity, but once this aging is complete and you have elected to pursue an appeal, your goal should be to file the appeal within one week. Knowing when to pull the plug on a costly appeal can prevent further bleeding.

Strive to gather costs related to appeals so that you can make informed decisions on which types of appeals you should be pursuing. Cost analysis should be a key factor driving those previously mentioned business rules.

Performance Monitoring and Staff Optimization

Even smaller staffs should be subject to performance monitoring. The ability to determine which appeals coordinator is most effective at what types of appeals will increase your success rate and help speed the appeals process.

Authoring appeals correspondence is not a simple task, but effective correspondence writing is a learned skill. Ensure your less successful coordinators learn from their more successful counterparts.  And of course, supply any needed supporting documentation such as medical records or images.

Utilization Management (UM) is often an under-used resource in appeals management. According to the healthcare Financial Management Association, “Comprehensive hospital UM are important not just in preventing denials, but in filing successful appeals.”

Recovery Audit Contractors (RAC)

As claim activity has slowed during COVID, both commercial and Medicare audit contractors are scouring encounter data to identify records that may be audited for potential takebacks (where possible) and preventing future improper payments. Look for trends in these “additional development required” (ADR) requests and respond promptly with all documentation needed to meet the requirement.

Since the third quarter of 2020, COVID related audits are being examined by commercial payers. So be aware that these auditors are particularly looking for incomplete documentation on inpatient stays.[2]

Benchmarking and analysis

In addition to appeals coordinator performance, analysis of denials and appeals should help drive maintenance on business rules.

Success rate and the associated administrative burden will reveal rule tweaks or modifications that will evolve your business model over time. These metrics may also help you see where you may have providers that require coding education. Benchmark your performance periodically. That stake in the ground will help you determine if your model is effective.

To learn more about how MEDHOST can help you with operations, denials management, and monitoring, please reach out to us at inquiries@medhost.com or call 1.800.383.6278

[1] Change Healthcare 2020 Revenue Cycle Denial Index Report.
[2] https://www.healthleadersmedia.com/revenue-cycle/audits-covid-related-inpatient-stays-are-here

Last week in part one of this series on revenue cycle management best practices, we discussed the importance of contract management and maintenance.

In the second portion of this three-part review, we take a closer look at another important facet of revenue cycle management (RCM) – billing flow, primarily, processes relating to pre-payment billing.

Why You Can’t Afford Billing Flow Errors

Billing flow is one of the areas most impacted by staff performance. It’s estimated that up to 80 percent of medical bills contain errors.[1] Denied claims resulting from billing errors most obviously impact how quickly a facility gets paid. However, the cost of appealing the claim is often overlooked. More importantly, high-dollar claims are cause for even greater concern as appeals are typically more complex and may require multiple levels of appeals. These high dollar claims typically require a higher cost resource in each subsequent appeal cycle.

Elevated Importance of Pre-Payment Billing Processes

To quickly and accurately reduce billing errors, every stage of the pre-billing process must be considered critical with a strict attention to detail. For example, Coordination of Benefits (COB) denials still occur routinely but are one of the most easily avoided types of denials.

Accurate gathering, verification, and recording of the patient’s insurance information—key aspects of COB—may not seem challenging, but difficulties within this process are compounded by regulatory and economic drivers. For instance, as more patients become insured, lose insurance, or pick-up employer sponsored plans, more variables are thrown into the equation.[2]  These complications further re-enforce the need for vigilance and a high level of attention in COB and other pre-billing processes.

One of the less glamorous, but still important, RCM performance metrics is “discharged not final billed” or DNFB for short. This is the ratio of accounts held for billing. Poor documentation and coding during the episode of care can significantly and adversely impact the process of completing a patient’s chart, and coding and abstracting. For these reasons, proper recording of a patient’s status and place of service are also important components to creating a correct bill.

Clean Claim Rate or Real Revenue?

It is common to read a lot about clean claim rates (CCR). Most RCM consultants aim for hospitals to achieve a CCR above 90 percent and many clearinghouses will promote clean claim percentages over 95 percent.[3]

How important is that metric?

True CCR as promoted by clearinghouses refers to the percentage of claims that are accepted by the payors from the clearinghouse.  Given the complexity of scrubber rules this number should be high.  However, it does not directly correlate to a low percentage of denials and underpaid claims.

A better metric to focus on is the first pass yield which is the percent of claims that actually get paid upon their first submission and how completely they are paid.

Reducing claim denials and maximizing full and timely payments requires pre-billing processes that incorporate detailed performance monitoring and insight at every stage. The bulk of these processes will rely heavily on your staff and their ability to execute with both accuracy and speed.

A hospital business office focused on performance improvement via processes analysis will often find itself worrying less about clean claims, focusing more energy on ensuring faster and consistent returns.

To learn more about how MEDHOST can help you with operations, analytics, and performance monitoring, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

[1] Gooch, Kelly. (2016). “Medical billing errors growing, says Medical Billing Advocates of America.” Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/finance/medical-billing-errors-growing-says-medical-billing-advocates-of-america.html
[2] Benjamin D. Sommers & Sara Rosenbaum, “Issues in Health Reform: How Changes in Eligibility May
Move Millions Back and Forth Between Medicaid and Insurance Exchanges.” 2011                                                                    
[3] https://revcycleintelligence.com/news/clean-claim-write-off-metrics-key-to-diagnostic-provider-success#:~:text=Experts%20across%20the%20industry%20agree,before%20they%20can%20be%20reimbursed.

Almost 50 percent of rural hospitals in our country are operating in the red, and over 450 are at risk of closing.[1]

As regulatory and market drivers squeeze margins, hospitals are taking a long look at areas that might have an immediate and positive impact on their cash flow, and the revenue cycle management (RCM) is one of the “usual suspects.” In this series we will delve into some of those RCM pain points.  Our first topic — while critical — is not one that is necessarily top-of-mind in a typical “RCM” discussion: contract management.

Providers annually dedicate approximately $157 billion to manual contract management.[2]  An often-overlooked component in the revenue cycle, contract management and maintenance is essentially the template for revenue and compliance planning. Success in negotiating agreements with payors, labor, vendors, Group Purchasing Organizations (GPOs), and facility and equipment contractors (among others) can have a significant impact on revenue. The process of contract development is well-documented. There are many tried and true steps to contract development that include workflow and process automation, a central document repository with audit tracking, linking to regulatory and policy documents, and appropriate representation on the development team. One of the finest corporate attorneys I ever worked with told me “a contract is only good if it can be signed.” That was her way of encouraging me to consider both parties in the negotiation. One of the best CFOs I ever worked with gave me another great bit of insight which was “a contract will perform as poorly as you let it.” That was his way of introducing me to performance metrics.

A hospital may believe they have negotiated a fine contract, but without an effective means of payor and contract monitoring, it can be a challenge to know if that’s really the case. A contract may be performing particularly well for a period and then start realizing occurrences of specific types of denials, down-coding, or underpayments. At an average cost of $118 per appeal, this cost can be significant.[3]  Effective analytics and performance monitoring should provide insights into your denials. The critical information like below should be analyzed:

A quality analytics approach should also allow you to see performance comparisons: provider to provider, payor to payor, and contract to contract. Not only can this information help you in preventing denials it can also help you in subsequent contract negotiations.

To learn more about how MEDHOST can help you with operations, contract management, and monitoring, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

[1] Chartis Center for Rural Health:  https://www.chartis.com/resources/files/Crises-Collide-Rural-Health-Safety-Net-Report-Feb-2021.pdf
[2] Black Book Market Research: https://www.blackbookmarketresearch.com/
[3] Becker’s Hospital Review https://www.beckershospitalreview.com/finance/denial-rework-costs-providers-roughly-118-per-claim-4-takeaways.html