Healthcare Contract Management

1
What is Healthcare Contract Management in Medical
Billing?
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2
Introduction

• US healthcare facilities and companies sign up
  contracts with a wide range of
• insurance companies every year. All payers have
  different policies, standards, parameters and
  regulations to follow. Therefore, keeping track
  of all contracts is an enormous task, especially
  when the US healthcare industry is observing so
  many new reforms like the ICD-10 Code Set
  Implementation.
• To streamline the contract and policy management
  processes, Providers should consider outsourcing
  to medical billing companies. This way, they will
  get paid as per their managed care agreements.
  Lets delve deep into the topic.

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3
What is Healthcare Contract Management?

• Patients have different insurance policies and to
  tend to them, Providers and healthcare facilities
  tie-up with many insurance companies.
• They sign healthcare contracts that are legal
  documents containing medical service repayment
  details. In this fast-paced, competitive
  industry, time is money! So, most Providers focus
  on patient care and overlook the vital clauses
  affecting the contracts or negotiate a good rate.
  
• There are also other elements like what benefits
  are covered, stop-loss provisions, incentives,
  service accessibility issues and provisions for
  counting/allocating members.
• All of these factors have to be properly analyzed
  and managed. If not, Providers will experience
  delayed and improper payments.

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4
Recurring Event

• Providers and healthcare organizations signing up
  contracts with Payers is not a one-time event. It
  happens every year! So, they have to
  re-credential with each Payor annually.
• The contract rates of each insurance company are
  revised and updated, yearly.
• Its not an easy task to review each Payors
  updated policies and contract rates every year.
  To do that, Providers will need the help
  of medical billing companies.

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5
What does an Experienced Medical Billing Company
Do?

• An outsourcing company identifies the top 5
  payors of a Provider/healthcare facility and
  check if they pay as per the contract.
• It creates and maintains a database to manage
  healthcare contracts. The database shows the
  policies and fee schedules of different Payors.
• For easy accessibility, the Payors are
  differentiated into Government, managed care and
  commercial.

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• Using this database, a medical billing
  company can easily track payments. Also, it can
  identify which Payor didnt pay and analyze the
  next steps to get the owed payments. 
• The company does a thorough analysis of the
  Payors contracts and keep an eye on what is
  changed and what remains.
• It outlines procedural details and risk
  mitigations while enunciating key clauses and
  offering unlimited templates during the
  re-credentialing of the healthcare contract
  management process.

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7
About US

• If you are looking for a reputed and
  skilled healthcare contract management company,
  then MGSI is your best bet. Whether it is
  credentialing or re-credentialing, this
  Florida-based medical billing company takes care
  of everything as it has more than 20 years of
  experience in the domain.
• One of the best medical billing companies in the
  US, MGSI will negotiate the right agreement that
  will create a long-term Payor-provider
  relationship. To learn more details, log on to
  www.mgsionline.com.

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8
Thanks!
Any questions?
You can find us at info_at_mgsionline.com or call
us 1-877-896-6474
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