The payer policy roller coaster has taken some twists and turns recently, with providers left out if they try to keep up with payer demands using only manual systems. Track changing payer requirements Long a major challenge for providers, some changes in the reimbursement space have prompted payers to implement updates at rates that providers may struggle to match. More flexible policies allowed during the pandemic are being rolled back, changing employment patterns are impacting the administration of insurance plans, and new clinical delivery models such as telemedicine require different coding structures. J. Scott Milne, said senior director of product management at Experian Health“We’re seeing an uptick in the number and speed of payer policy changes, updates, requests, and terminations. There’s a lot of information to have, especially if you’re trying to do it manually.”
Healthcare providers who fail to keep up with these changes can end up wasting a lot of time and resources rework claim. Instead, they should consider using Automatic Payer Alerts To reduce administrative burdens, control rejection rates and protect profits.
Automated Payer Alerts Give Providers the Power of Knowledge
For many providers, understanding payer requirements includes periodic reminders to check payer websites, subscribing to payer newsletters or social media accounts, or perusing industry media coverage for possible changes. If these checks are automated, suppliers can save hours of valuable employee time and be confident that no important details will be missed.
with automation Payer reminder, providers have instant access to payer policy and procedure changes they are busy capturing. This is an easy and convenient way to monitor modifications so claims can be submitted correctly the first time. This means employees can spend less time researching program changes. Through an online portal and daily email summaries, providers can receive timely alerts on payer changes posted on more than 120,000 different web pages. Each notification is the result of extensive behind-the-scenes work in Experian Health’s proprietary software. The program generates alerts with a detailed summary of changes, links to affected policies, and a breakdown of changes in healthcare specialties. This allows providers to prioritize those most relevant to their organization.
“Payer Alerts brings the power of knowledge to our clients,” said Milne. “We track over 120,000 web pages daily to uncover changing policies. Alerts are sent to providers’ desktops daily with the most relevant payers Policy information. This means organisations know how to respond and can make the necessary updates to protect their revenue cycle.”
Customer Success Story: Payer Alerts Deliver Big Returns
Knowing what is and isn’t covered enables providers to better protect revenue by allocating resources more efficiently, minimizing claim rejections and avoiding missed revenue opportunities.Headquartered in New York University Physician Network (UPN) Implement payer alerts to help physicians avoid denied claims.
“Payers are increasing their editors, but if you know them ahead of time and can make the necessary adjustments, you can avoid rejections and time-consuming appeals,” the CEO said. With Experian Health, we now have an automated, A straightforward process that helps us minimize unnecessary rejections and take a proactive approach.”
A UPN group recovers $42,000 Payer alerts due to individual policy changes.
Amplify results with the right healthcare payer solution
Payer Alerts doesn’t just help healthcare organizations streamline workflow and maximize revenue through its immediate capabilities. Its compatibility with other automated healthcare payer solutions creates the perfect defense against payer reimbursement challenges.
For example, combine the payer alert with Contract Manager and Contract Analysis Help hospitals manage multiple payer contracts and check that the correct amount has been reimbursed. Contract Manager allows providers to monitor payer performance and arm them with data to negotiate more favorable contracts. It generates reports that support better communication with payers. This results in fewer calls to resolve issues and reduces the likelihood of misunderstandings about a patient’s insurance status or whether a claim has been received.
Similarly, claim scrubber Review each claim with payer alerts and verify that they are correctly coded before sending to payers to reduce the risk of rejection. Claim Scrubber now also includes billing modifiers designed to support compliance Appropriate Standard of Use program.
Keeping pace with regulatory changes
Going forward, providers must continue to monitor legislative changes affecting payer strategies.implementation of no surprise bill Relevant legislation should improve transparency and more effective data sharing in the healthcare community.However, it also brings stress Payer-Provider Relationship. Payer rules may continue to change, which means that payers may interpret these rules differently.Experian Health Regulatory Solutions Can help providers navigate these changes and avoid penalties.
Ultimately, providers can’t respond to changing payer policies if they don’t know these changes have taken place. While change is inevitable, precious time and revenue will not be wasted by inefficient manual processes. By investing in automated healthcare payment solutions, providers can adapt to change and stay ahead.
Learn more about Experian Health Payer reminder Can help healthcare organizations obtain the necessary information to make timely strategic decisions to protect profits.
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post How to keep up with changing payer requirements first appeared in Healthcare Blog.
