• Ep. 34 Maximizing Provider Revenue with Payer Contract Insights

  • Sep 23 2024
  • Length: 33 mins
  • Podcast

Ep. 34 Maximizing Provider Revenue with Payer Contract Insights

  • Summary

  • 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

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