Here is the most important revenue question for medical practices this quarter: what is the contracted rate with each payer for each plan in the facility? Are we getting paid the contracted rate on every single claim? The health of provider’s bottom line rides on the answer. Healthcare payer contract management is the lynchpin between healthcare facilities and the healthy revenue that makes them sustainable.
It might surprise you to learn how many practices large and small do not regularly check their payer contracts and how many do not know their contracted rate. A survey by the Medical Group Management Association(MGMA) found that nearly one-third of practices check their contracts only when an issue arises.
Given the number of payers that any healthcare organization may contract with, the only way to monitor payments and ensure every claim is paid the contracted amount is with robust healthcare contract management software. It is the key that unlocks healthcare revenue recovery.
Collected vs. Collectable metrics are becoming more important for healthcare providers
Certainly, there are many important metrics in a medical practice. However, when it comes to managing payer contracts and collecting every dime that is owed, there is one that is becoming a greater concern for healthcare providers – collected vs. collectable (CvC).
Specifically, CvC is the cash that is actually collected from payer contracts compared to the cash that should have been collected. Monitoring, measuring and reporting CvC takes revenue management to an entirely new level. It gives practices a 30,000 foot view of revenue while also providing granular detail of collected cash versus collectible cash. Once that is understood, managing the organization’s revenue cycle and performance becomes easier because it’s based on actionable data.
CvC is most easily provided through healthcare contract management software. Leaders in the industry, like Revenue Masters, now make it available through a mobile app that delivers a comprehensive list of benefits in a pocket-sized dashboard. It brings revenue cycle management (RCM) into the 21st century and gives managers a digital solution that delivers rapid data on denials and underpayments. When the fiscal obstacles created by delayed data and slow denial responses are eliminated, revenue can improve.
The information delivered by CvC drives powerful analytics and facilitates proactive revenue management. Granular detail will show inconsistencies in payments and net collection rates. The Healthcare Financial Management Association(HFMA) gives a good example of how CvC is an outcome, rather than a process:
“A health plan is consistently paying incorrectly for certain office-based procedures. Unless these procedures represent a very large percentage of total charges, the net collections rate will not indicate a problem. Even if net collections were noticeably low, the standard approach would be to examine payer denials. In contrast, finance leaders who monitor CVC will detect consistent underpayments very quickly. Once CVC declines, managers can drill down by CPT code and identify the specific procedures being underpaid. The organization can then approach the payer with concrete information about codes, procedures, and payment shortfalls. Payers are more likely to address and resolve underpayments when presented with data in bulk.”
Revenue Masters offers a free mobile app for Collected vs Collectable metrics
If information is power, then a digital solution gives RCM managers the powerful tool they have long sought. Along with healthcare contract management software, Revenue Masters offers a CvC mobile app, with CvC metrics that provide RCM insights and identify exactly where cash is being held up.
Revenue Masters CvC mobile app integrates features that deliver the ability to track key performance indicators, payments, denials, underpayments and outstanding revenue.
- Track and Compare key revenue performance indicators: Customized view by year, month, or week. Identify number of underpaid or denied claims with dollar amount and view historical comparison.
- Denials prioritized: See the top eight reasons why claims were denied, i.e. CPT, missing claim information, documentation/coding, etc.
- Status of payments posted: view the number of payments posted, dollar amounts, historical comparisons.
- Payer revenue forecast: view outstanding payer revenue awaiting original payment.
- Payer mix: displays the top eight payers with the largest percentages of claims.
The American Academy of Family Physicians (AAFP) tells its members that a 5 to 10 percent denial rate is the industry standard. It’s time for providers to take control of reimbursements wherever possible. A dollar contracted should be a dollar paid – that’s the bottom line. Integrating smart, digital, aggressive p contract management solutions into the healthcare organization is the only way to take back control. Fast data can lead to fast action and more cash in the door.
If you are a healthcare provider trying to learn more about your Collected vs Collectible, download the free Revenue Masters CvC Mobile App today to see a sample of how it works at the App Store or Google Play. See for yourself that CvC information is power for your bottom line.
Interested in healthcare contract management technology that can help you simplify denials and underpayments management? Call us today at (877) 591-2590 or email us at [email protected] to book an intro call with one of our senior reimbursement experts. Revenue Masters is dedicated to combining healthcare cloud contract modeling and management with fast and efficient payment recovery workflows to create the most advanced platform that enables 100 percent collections across all payers.
Revenue Masters healthcare contract management works for any provider who wants to ensure they are being paid as per their payer contracts:
- Healthcare Systems
- Critical Access Hospitals
- Physician Groups
- Ambulatory Surgical Centers
- Skilled Nursing Facilities
- Rural Health