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  • Writer's pictureMuhammad Sair Khan

The Keys to Success for Payor Reimbursement Management



Many healthcare providers are seeing higher numbers of claims denials as well as reductions in reimbursements from insurance companies. It’s also become more challenging than ever to navigate plans and collections. These payment issues can add up quickly, leading to hundreds of thousands of dollars or more of lost revenue.


Your facility or practice can help increase your reimbursements and avoid claims denials by using strategies to manage payor reimbursement.


Plan for Payor Tactics


Payors use different techniques to make it more difficult to follow up on denials and underpayments. You need to have a system in place, including the appropriate technology, to quickly handle these tactics and keep your claims appeals in progress.

In general, you need to be able to:

  • Quickly respond to requests for more documentation, including medical records and itemized bills

  • Be ready to prove medical necessity with each patient

  • Understand explanation of benefits statements

  • Develop an understanding and relationship with each payor

Payors will try to delay or reduce payments. You need to be ready to prove that you have earned your revenue.

Create a Great Billing and Collections Process


You need to have a process in place to submit and follow-up on claims, particularly aging claims. Following the same process with each claim will help you move more quickly to get these claims paid or appealed.

Your process should include:

  • Collecting the right information at patient intake to receive prior authorization

  • Careful record keeping of the patient’s stay or visit, including double checking for typos or missing information

  • Regular reminders or alerts about aging claims so you follow-up in a timely manner

  • Sending any documentation with a tracking number or other way to ensure insurers have received the information

  • Keeping notes of all communication with the insurance company until the claim is paid

Many providers miss out on revenue because they don’t have the time to follow up on accounts receivable. Creating a more uniform process can save time, helping you recover revenue you’ve earned.

Review Your Data


A regular review of your accounts receivables may reveal trends that help you correct common problems. For instance, you may notice that payors often reject a certain billing code and can take steps to ensure you use the appropriate code in the future.


Data review can also help you better project your expected revenue over the next year and plan appropriately. Understanding where your revenue is coming from can help you look for opportunities to expand that revenue. For instance, you may find that going in-network with a payor who is popular in your area may speed up the claims process and result in fewer denied claims.


You can’t know what changes to make to your billing and collections process until you review the data. Review your data on a regular basis, such as every quarter, to ensure you understand your revenue.


At Datapro, our experts can help you better manage reimbursement to increase your revenue. Contact the Datapro billing team today for a complimentary unpaid claims review and to learn more about our services.

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