In a Medscape Business of Medicine article, Penny Noyes, president and CEO of Health Business Navigators, discusses phrases and clauses in your payer contract that are hidden threats and could end up costing you.
Here are the nine things to know about payer contracts:
1. Timely filing of a clean or complete claim.
2. Some contracts specify that if another contract contradicts your practice contract, then the other contract will supersede yours — ensure your contract is not undermined.
3. Know whether you are participating in a health insurance exchange.
4. Ensure that the contract reflects agreed upon terms.
5. Be sure you understand whether a site-of-service differential applies to certain services, such as surgical codes.
6. Make sure that you know if the payer can pay you more for lab tests, durable medical equipment or radiology services.
7. If the rates are tied to Medicare, make sure you know the specific year and locality.
8. Make sure your agreement provides the same time period for either party to notify the other that a payment error has occurred.
9. If you are planning on joining a clinically integrated network or accountable care organization, be aware of how much authority you are giving them when you join.
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