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Contracting

Contracting

Medicaid Audit

Medicaid Fraud Enforcement Is Getting More Aggressive — Here’s What You Need to Know

If you participates in Medicaid, Medicare, or managed care programs, your compliance risks are growing quickly. Federal agencies are dramatically increasing healthcare fraud enforcement efforts, and physician practices are now facing far more scrutiny around billing, eligibility verification, medical necessity, documentation accuracy, and reimbursement reporting. What used to be treated as a simple billing mistake […]
medical practice reimbursement

How Your Medical Practice Really Gets Paid — And What You Can Do to Increase Reimbursement

If payer reimbursement feels confusing or unpredictable, you’re not alone. Many medical practices lose revenue every year—not because they’re providing the wrong care, but because they don’t fully understand how payers calculate payment or what levers they can control. Small misunderstandings in reimbursement methodology often lead to underpayments that go unnoticed for months or even […]

Rank Your Insurance Payers to Evaluate Which Stay, Which Go

Your practice doesn’t necessarily need to expand your hours or bring in new patients to collect more income. In some cases, you may simply have to evaluate your insurance payers to determine which ones are paying you enough and which are causing you to lose money. One way to ensure you aren’t leaving money on […]

Are Revenue Cycle Bottlenecks Costing Your Practice Thousands?

Dr. Lopez’s busy orthopedic practice submits hundreds of claims every week. But with denials creeping up, the billing team is constantly resubmitting claims. One front-desk employee, unfamiliar with payer rules, keeps entering incomplete patient insurance data—forcing staff to chase patients for missing information. Meanwhile, credentialing delays keep a new physician from being properly enrolled with […]
Payer contract

3 Considerations You Must Make Before Dropping a Payer

Every payer contract your practice signs is a legal document that should not be taken lightly if you’re thinking of terminating it. But you should have a plan in place in case you’re ever in a position where a particular contract simply isn’t tenable for the long term. Check these three considerations every practice should […]
Contract negotiation

3 Payer Contract Negotiation Pitfalls Every Practice Must Avoid

Participating in a managed care contract negotiation cycle can often help your practice create more favorable terms and allow you to increase reimbursement and decrease administrative burden. While it may be a stressful time, it’s also an opportunity to improve unfavorable contract terms that you’ve dealt with for too long. What’s important is to take […]
Managed care contracting

8 Managed Care Contracting Tips to Solidify the Terms You Need

Managed care contracting can strike fear in the hearts of even the most seasoned medical practice manager. One bad contract term can haunt you for years, particularly when it affects the income you’re bringing in. Your best bet is to do some legwork before you sit down at the negotiating table. Check these eight managed […]
Contract negotiations

How to Respond When Payers Say ‘No’ in Contract Negotiations

Handling payer contract negotiations is never simple, and one area that many practices find particularly stressful is how to respond when a payer immediately says “no” to the terms you’re interested in pursuing. Although it can be off-putting to deal with an insurer who doesn’t want to work within your required terms, there are ways […]
Insurance contract

How to Leverage Your Strengths During Payer Negotiations

Once you’ve scheduled an insurance contract negotiation meeting with payers, you can’t simply breeze into the room without significant preparation. The best way to have the payer accept your terms is to identify any and all leverage you can use in the contracting process, and that’s easier said than done. It requires research and due […]
Insurance contract

How to Time and Schedule Your Insurance Contract Negotiations

Handling health insurance contract negotiations can give any practice manager a headache. There’s so much to remember, including which terms to avoid, who your contact should be at the payer organization, which rates work best, and much more. Among the issues that many practices struggle with is how often to renegotiate with payer sources. Read […]