Practice Management Alert

You've done everything to improve your collections trained your staff, cleaned up your claims, posted appeals but there's still a mysterious leak in your revenue barrel. It's time to go back to the drawing board and your third-party contracts, and plug up limitations to collect profits. Did you know that contractual issues cause 20 to 30 percent of potential revenue to go uncollected? That's what statistics from the Medical Group Management Association (MGMA) showed consultant Marsha Diamond, CPC, owner and instructor of Coding Programs, Medical Professional and MD Consultative Services. Third-party contracts stipulate what you can and can't seek payment for, which means they can legally hamper collection possibilities. When you expect payment, the payer can deny it if your contract doesn't specifically cover it. Or you can miss out on payment guaranteed in your contract because you're unfamiliar with its fine print. To avoid this pitfall and boost accounts-receivable revenue, take control of third-party contracts with these three strategies:
Learn your contracts inside and out
Develop methods for increasing reimbursement within them
Design a method of contract compliance. Begin your new contract approach with this preliminary rule of thumb: Deny, scrap or revise future standard contracts. Remember, the payer is looking out for its best interest, Diamond warns, so the standard contract its representative presents is a bargaining pact, not a final deal. It will usually offer two different methods for paying so that the carrier can pay the lesser of the two. If a payer's representative does hand you a standard contract, request the changes that you'd like to see benefit your office and minimize payer limitation guidelines. Know Your Contracts "Knowledge is control," Diamond says. Know what your contract does and doesn't address, so you can revise any specific deficiencies and ensure adherence to all of the contract guidelines, she advises. Here's what you should look for when assessing your contracts:

1. Coding limitations. Unclear, ambiguous or missing statements in the contract can limit how much payers reimburse for certain codes, Diamond warns. Check to see if your contract explicitly addresses:
what the global package encompasses
coverage for your practice's unusual services
bundling and unbundling issues
modifier use (For more topics your contract should address, see "Include These 'Must-Haves'in Third-Party Contracts" in article 2). 2. Contract language. Ensure that the wording of your contract addresses coding and not just legal issues. The standard contract is several pages long but deals mainly with legal issues, and "too little coding means too little reimbursement," Diamond says. To further reduce ambiguity, tailor contract language to your specialty's needs, she adds. 3. Coding and billing guidelines. For all services listed in your contract, you want to [...]