The Successful Contracting Campaign

PREPARATION – EVALUATION – NEGOTIATION – DOCUMENT REVIEW – IMPLEMENTATION – REVIEW

By: Kena Galvan | Absolute Solutions

Contracting takes time. The proven steps to a successful Contracting Campaign:

1. PREPARATION includes gathering all contracts, scanning the documents, and then creating a spreadsheet of key terms. It is rare for a practice to have all their contracts accessible and many will need to be obtained from the payors themselves. As we gather the documents they need to be scanned. Both the preparation time and scanning time are considered Administrative and can be performed by our staff or yours. Once the documents are scanned a Skilled Associate will review the documents, extrapolate the pertinent terms and summarize on the Payor Contract Matrix. This task is best served by our staff as their experience guarantees accuracy and expediency.
2. EVALUATION consists of reviewing the Payor Contract Matrix and your Billing Data to design a Contracting Strategy specific to your practice. The Contracting Strategy’s objective is to identify the Leverage (what makes your practice special), define the plan-of-attack using objective criteria, as well as set contracting goals. It is an evolving document, updated at least annually, to reflect on the ever changing needs and trends. The Contracting Strategy is drafted by our Contracting Experts and then fine-tuned with you and/or your physicians.
3. NEGOTIATION combines data, market trends, Leverage, and payor relationships. Some negotiations take two weeks, others take six months. There is no way to predict the time frame as we are often at the mercy of the payors. If stagnant, we will evaluate the termination option to force the payor into action. Negotiations are managed by our Contracting Experts; however it is common to enlist an outraged physician who can pine about ridiculous underpayments or a physician who has good relationships with board members. We Leverage what we have to obtain the best outcome.
4. DOCUMENT REVIEW is crucial to ensure the deal you thought you struck is what you end up with on paper. It also includes reviewing key terms for crucial items such as claims submission, appeal time frames, termination. This is handled by our Contracting Experts.
5. IMPLEMENTATION is a team effort and requires collaboration from everyone. Our Contracting Experts and Skilled Associates will update the Payor Contract Matrix and educate your billing and management teams on implementation. This may involve your software support to load fee schedules as well. The payments will be monitored closely after implementation to ensure the payor implemented on their side correctly.
6. REVIEW is the ongoing process of monitoring the results of your Contracting Strategy. It is recommended a summary audit is completed to measure the results at quarterly intervals on an ongoing basis. The Review is performed by our Billing Optimization Team.

Common Contracting Terms:

• Billing Data – the data generated from your billing system providing reports, claims data and payor responses.
• Contracting Strategy – The written plan-of-attack to manage your contracts.
• Leverage – What makes you and your practice special.
• Payor Contract Matrix – the master document containing the key components to each of your contracts which should include, rates, effective dates, term and termination provisions, billing limits, appeal time frames and other nuances specific to your agreement.
• Review – The process documented in the Contracting Strategy of looking back at the impact and effectiveness of your actions.

Questions or Comments?

Contact Kena Galvan ([email protected]) at Absolute Solutions (858-256-0351) for more information.

Absolute Solutions is a full-service medical billing and consulting company dedicated to the healthcare industry. We are committed to surpassing your expectations by assessing the state-of-affairs, developing clear and attainable goals coupled with innovative implementation plans to increase efficiency, streamline operations, and add value resulting in a maximized bottom line.