Why Payer Relations Benefit Providers

In this new era of ICD-10, having qualified payer relations staff on your side can mean the difference between approval and denial for large swathes of claims, possibly worth millions of dollars meant for your facilities. Creating and maintaining these relationships can be incredibly time intensive and complicated.

That is why partnering with a third-party organization that already has these connections can be a huge asset to you and your team. They can come alongside your staff to conduct an initial evaluation of the current state of your insurance practices and reimbursements. From there, they can summarize the opportunities, propose a resolution plan, and set the stage for any future Payer Relations initiatives.

What Are the Benefits of Payer Relations?

Denial Management may be the first thing that comes to mind when you think payer relations but an experienced company familiar with the revenue cycle can provide so much more than that. A successful effort should have your partner looking for any pain points or ways to make the process more efficient.

When was the last time you truly went over your insurance plan for any updates? Member policy groups often have changes that impact plan language and payment calculations. A diligent partner reviews these changes regularly to ensure claims are submitted properly and accurately, therefore avoiding denials and processing delays.

Contract modeling, forecasting and compliance testing can help get you out ahead of any issues you may face or that may be heading your way in the future. By analyzing your claim information and creating models to explore any “what if?” scenarios you can be prepared for the unexpected and get a better idea of how to better negotiate future contracts with payers.

Payer Relations are Becoming More Important than Ever

Having an established infrastructure and strong collaboration with the industry’s top national, regional and local medical and pharmacy insurance payers is key to maximizing any organizations collections while maintaining compliance with billing and processing regulations.

Over the last several years and especially in the last several months, there have been extensive insurance payer consolidations through mergers and acquisitions. In most cases, these mergers entail complex system integration and changes to ensure claims are processed in accordance with 38 CFR. Proactive companies, like Signature Performance, have maintained effective relationships with key personnel to secure payer compliance and timely, accurate claims processing.

Add on top the confusion of new ICD-10 guidelines and you have a recipe for a denials disaster if you don’t have the proper lines of communication in place. Could finding a teaming partner with strong payer relations be right for your organization?