Where are your physician’s managed care provider agreements?

After a managed care contract is signed, it is important to make sure the office handles these payors correctly, handles their patients correctly, and makes sure the office continues to operate efficiently. As managed care continues to dominate a physician’s revenue stream, many practices find their offices become inefficient due mainly to all of the administrative burdens placed on it by managed care and lose revenues as a result of these inefficiencies. After signing managed care agreements, it is important to monitor practice compliance with them. First, the office should place all of their managed care information in to notebooks for easy access so that the office can effectively monitor these relationships.

For each managed care payor, the notebook should contain:

• A copy of the executed managed care contract;
• Reimbursement schedule for the practice’s most commonly utilized services;
• Any of the payor’s specialized forms, such as provider referral forms, and patient authorization forms.

Always remember that you should compare its managed care reimbursements to the agreed upon reimbursement schedule included in the managed care notebook for each payor. Payors do make mistakes reimbursing providers, often many more times than doctors realize.

Many practices find that in certain instances, what was approved for payment is different than the reimbursement schedule. This is why it is so important to monitor managed care reimbursements.  Therefore, each week take a sample of managed care EOBs (Explanation of Benefits) and compare the reimbursement to the amount shown on the reimbursement sheet in the managed care notebook. Differences should be appealed immediately. Of course many practice management systems today can be set up to monitor incorrectly payor reimbursement.

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.