Sep 22 2024 32 mins
Maximizing Provider Revenue with Payer Contract Insight
In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares essential insights on how to maximize provider revenue by understanding and leveraging the nuances of payer contracts. Topics covered include addressing prior authorization denials, navigating payer reimbursement policies, ensuring clean claim submissions, and utilizing fee schedules and carve outs. Additionally, Vanessa offers strategies for managing payer plan limitations, timely filing guidelines, and escalation procedures for unresolved reimbursement issues. Listeners are encouraged to harness technology and AI-driven solutions to streamline these processes for enhanced revenue cycle performance.
00:00 Introduction to the Podcast and Host
01:23 Episode Overview: Maximizing Provider Revenue
02:01 Understanding Payer Contracts
03:04 Prior Authorization Guidelines
05:28 Payer Reimbursement Policies
08:08 Clean Claim Requirements
11:34 Carve Outs in Payer Contracts
14:03 Payer Plan Limitations
16:24 Fee Schedules and Contracted Rates
21:29 Requests and Recoupments of Overpayments
23:34 Denials Without Proper Justification
25:10 Timely Filing Guidelines
27:17 Escalating Reimbursement Issues
29:11 Conclusion and Next Steps