Three Tactics to Preempt Payer Headaches

NORWALK, Conn. — A physician practice’s revenue cycle is rarely seamless, largely due to the challenges of managing different and ever-changing rules and idiosyncrasies of various payers. Indeed, in a recent article for Physicians Practice, medical billing consultant P.J. Cloud-Moulds described the experience of working with payers as a “game” in which she applies her knowledge and persistence against obscure payer tactics.

Nonetheless, getting paid by insurance companies is a game of high stakes. Consider the following pro strategies to improve your odds:

• Take the time to figure out each payer. Even with the advantages of an in-house centralized billing department, Dr. Jane Siegel, a Nashville-based orthopedic hand surgeon, told Physicians Practice that her organization tailors its claims process to each insurance company. Billers track payer characteristics such as whether they’re likely to bundle claims or reject certain codes, for example.

• Track claim turnaround. As part of getting to know each payer, practices can usually find a pattern in how many days it usually takes particular payers to process claims, noted David Doyle, CEO of revenue-cycle management firm CRT Medical Systems. High performers, therefore, take the next step and track how long claims take to get a response. “When you know [it is late], don’t let a claim sit there and, so to speak, languish,” he said.

• Read all correspondence from payers. Payers can legally change contract terms with little to no warning, which makes it essential that someone in the practice keep track of quiet announcements that may arrive through channels such as payer newsletters. This habit begins, of course, with reading the initial contract thoroughly. Practices should be on the lookout for ‘all-nations’ clauses, which can enroll a provider involuntarily into a payer’s healthcare exchange plan, advised consultant Owen Dahl.