Monitor Payer Contracts to Help Manage Revenue

Keywords: Reimbursement  


A 2004 survey by the Medical Group Management Association revealed that medical practices that don’t track their payer contract rates are reimbursed on average 4 percent less per evaluation and management code billed. Family medicine practices reported a 7-percent difference. This can add up.

Monitoring the contracted rate in your payer contracts is an important step in managing your revenue cycle. Are you receiving the full payment due your practice for every claim you file?

You can start by creating a simple spreadsheet to track just the private contractors that account for most of your revenue, and the contracted allowable for the 25 or so codes that make up most of your billings. Use the spreadsheet as a tool for making sure that each plan pays you appropriately.

  • Compare your billed charges with your contracted rates to make sure you are not billing below the allowable rates.
  • Train your staff to flag claims payments that are below the contracted rate, and assign someone to follow up.
  • Compare the allowables to Medicare. Rates less than or at Medicare rates are not reasonable, and are ripe for renegotiation at contract renewal time.
  • Note when contracted rate adjustments are scheduled to go into effect so you can make sure the payer honors the new rate.

New From TMA! Recorded Web Seminar

If you were unable to attend our seminar earlier this year on revenue cycle management, you now can learn the same valuable information and techniques from our new recorded Web seminar, now available to order.

Revenue Cycle Management” is a three-part program featuring nationally known speaker and author Elizabeth Woodcock sharing key aspects of revenue management in these on-demand, one-hour sessions: (1) The Pre-Encounter, (2) The Post-Encounter, and (3) Metrics and Measures.

Register now for this three-part Web seminar. Within two business days, you’ll receive a confirmation with a link to view this prerecorded program on your computer at any time, at your convenience.

If you have questions about this program or need help registering, contact the TMA Knowledge Center at (800) 880-7955. Watch for more TMA recorded Web seminars to come!


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Last Published: 10/30/2009

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