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The Rosetta Stone of Managed Care: Contract Language Scorecard
When reviewing contract language for managed care payor contracts, organizations should keep several goals in mind. The contract language scorecard is a tool organizations can adapt to help systematically review contract language for managed care "Payer" contracts and help achieve their goals.
Negotiating the Behavioral Health Contract
Negotiating managed care contracts can be challenging enough; negotiating behavioral health managed care contracts involves overcoming an extra hurdle or two in order to maximize reimbursement. Employing contracting strategies that protect reimbursement is critical because reimbursement rates for psychiatric care are lower than for medical care.
Contracting Against Never Events
Although there has been no uniform private payer policy regarding never events, one thing is certain: sooner or later payers will be addressing the issue, which means that hospitals need to be prepared by making sure they understand their obligations and responsibilities with respect to never events.
Payment Reform: What’s on the Horizon
One area that seems destined to see change is the payment system, which many say fosters expense and lowers quality. The specifics are still in the working stages so exactly what these next few years may bring is up in the air , but there are some areas in the current payment system that are ripe for reform.
How to Audit Managed Care Contracts
As providers are faced with increasing pressure to their bottoms lines, the importance of both generating and protecting existing revenue is paramount. The managed care contract audit may help protect revenue.
What Are the KPIs for Managed Care?
Depending upon a provider’s strategic goals, KPIs are used for any number of reasons, from negotiating better contractual terms to tracking negative trends and identifying problem areas. Here are some suggestions.
Best Practices for a Denials Prevention Program
Looking out for their own bottom lines, payers issue denials on payment of an insurance claim for a host of reasons, from a lack of medical necessity and preauthorization to inaccurate coding and duplicate claims.