n this article, we will examine three analytical techniques for increasing your commercial payer contracts’ reimbursements:
1) Use weighted averages to calculate your reimbursements, 2) Avoid the infamous “Lesser of” Billed Charges or Contracted Rate problem and 3) Focus on your most important codes.
When negotiating payer contracts, it is key to do your own data analysis of your contracts to effectively increase your reimbursements.
This work should be done, up front, prior to negotiating any contracts. Always rely on your billing system and your own data to determine your revenues. While payers track revenues too and can provide you this information, it may not be consistent with your own internal tracking data. You should be able to find
1) Use weighted averages to calculate your reimbursements, 2) Avoid the infamous “Lesser of” Billed Charges or Contracted Rate problem and 3) Focus on your most important codes.
When negotiating payer contracts, it is key to do your own data analysis of your contracts to effectively increase your reimbursements.
This work should be done, up front, prior to negotiating any contracts. Always rely on your billing system and your own data to determine your revenues. While payers track revenues too and can provide you this information, it may not be consistent with your own internal tracking data. You should be able to find