Three tips on testing contract compliance

3 Key Tips for Ensuring Contract Compliance in Your Medical Practice

It is important to test contract compliance with your plans in order to ensure that all rates and terms are being adhered to. Here are three tips to show you how:

1. First, make sure you can differentiate between your commercial payers and then even among products for a particular payer (e.g., BlueCross BlueShield HMO versus BlueCross BlueShield PPO) because each plan has different rates. Capture your data correctly on the front end. The data for each plan should be as specific as possible to make it easier to test for contract compliance. Among the pieces of information you collect, list the payer, product, and revenue, CPT, or HCPCS code. The data should also include what they billed and what they got paid. If there is a denial, include a reason code if you have one.

2. Next, take what they actually paid you and compare that to your fee schedule, which, if you can put it into an electronic format, will make things a lot easier on you. Get your fee schedule in the database, put your claims in a database, compare the two, and then investigate the variances.

3. If you have annual inflaters in your contract, then it is critical to complete contract compliance testing. As soon as those inflators kick in, providers should confirm that the terms of the contract took effect. This can be done on a sample basis. If you don't hold payers accountable, they might just overlook loading your inflator into their system.

Note that contract compliance should be conducted on a quarterly basis. By looking at this quarterly, you can catch any changes in coding edits or bundling procedures..

Don’t let contract discrepancies affect your practice’s profitability. With REED TINSLEY, CPA, you can ensure thorough compliance testing and keep your financial performance on track. Contact us today to learn how our expertise can support your practice’s success.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.