Determining Your Payer Strategy
Payer strategy starts with taking the first step!
Managing your practice's patient schedule, ordering supplies, and developing your staff.. it all takes time and attention. Payer contracting and keeping up with credentialing updates can often fall off the radar until an alarm bell goes off. Was a revalidation date missed? Did a new insurance or IPA add a line of business that your providers are not participating with? These are the types of topics that might come up when you are trying to understand drastic changes in your denial trends.
Revenue Integrity isn't a buzzword, it is the backbone of any thriving medical practice. While coding, and accounts receivables might be the first department you think about when you are deep diving into patient financials - often credentialing & enrollments is an afterthought. We hope to change this!
Having a team to help you proactively track upcoming recredentialing dates, submit license renewal applications and update your payer directory attestations before they are due can help avoid revenue impacts down the road. When you are ready to grow your practice and add a new provider, an efficient onboarding process will ensure your new provider is in network before they begin seeing patients. Tip: Please expect this process to take anywhere from 90-120 days depending on the payer.
If you have been credentialed and contracted for some time without a clear picture of your payer enrollments, we recommend starting with the first step in our process which is payer discovery. What does payer discovery entail? Our team reaches out to each payer on your list to verify participation details, upcoming recredentialing dates and verify your practice demographics. If you do not have copies of your agreements, the second step will be to reach out to the payers to request a copy of your fully executed agreement and fee schedule matrix for your top codes.
With this information in hand, analyzing your top payer mix and reimbursements will give you crucial data to decide which payer contracts are helping your practice grow vs those that have remained stagnant. To help practices through this process, it all starts with an easy introduction call for us to learn where your.pain points are. Let's chat!
