Know what you are owed, collect what you are due, and negotiate what you are worth.
With so much of healthcare reimbursement administered by contracts, oftentimes complex and requiring lengthy payment terms, it is not surprising that hospitals and health systems experience leakage in their revenue cycle. Revenue assurance through contract management can plug the leaks, preventing unplanned and unexpected cash outflow. Consider implementing net patient service revenue assurance measures. Integrating contract management into your revenue cycle can help you calculate your expected cash correctly and protect its inflow.
The average healthcare organization experiences a 5% loss in annual net patient service revenue due to preventable revenue leakage.* It is also estimated that 7-11% of claims are underpaid.** The American Medical Association estimated that 7.1 percent of paid claims contain an error. That means for every 100,000 claims your organization processes, 7,143 will be paid incorrectly.
At the heart of the issue is an organization’s ability to apply contract management control to its claims management and reimbursement cycles. Managing and maintaining dozens of payer contracts, each administrating different payment terms and conditions based on numerous factors, can make calculating expected net patient service revenue complex. But without that calculation an organization cannot identify the true worth of a claim or if the reimbursement received was in variance.
Imagine the power of being able to project your cash flow with confidence; to monitor and act on payment variances. What if you could recoup identified underpayments and shortfalls en masse with “one-click” ease? How would it improve your payer negotiations if you could analyze actual and expected cash flow by procedure, by payer, by contract? With the right contract management and modeling solution, you could gain the strategic control to prioritize and maximize your revenue results.
But what about the cost of implementation? No matter how good a contract management solution claims to be, it is only most efficient when it is seamlessly integrated with the industry’s best clearinghouse as its foundation. Learn more about the Quadax Contract Management Solution when you download the FREE e-book. Let us help you optimize your revenue cycle!
(*) source: 2016 Healthcare IT Forum, Advisory Board
(**) Medical Group Management Association (MGMA) Research