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Navigating payment pitfalls in managed care.

Bill Phillips1

  • 1Managed Care Recovery Corp., Fort Lauderdale, Fla., USA. billinfll@juno.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|February 27, 2003
PubMed
Summary
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Healthcare providers must track denied and underpaid insurance claims to improve revenue. Identifying total claim dollar amounts per payer before contract renegotiation is crucial for financial health.

Area of Science:

  • Healthcare Management
  • Health Economics
  • Medical Billing

Background:

  • Payment issues, including denied and underpaid claims, significantly impact healthcare provider revenue.
  • Effective revenue cycle management requires proactive identification and resolution of these financial discrepancies.

Purpose of the Study:

  • To outline strategies for healthcare providers to identify and address payment problems with insurance claims.
  • To emphasize the importance of financial data analysis prior to managed care contract renegotiations.

Main Methods:

  • Analysis of common payment issues in healthcare billing.
  • Recommendations for data collection and system selection for managing claims.
  • Guidance on financial assessment before payer negotiations.

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Main Results:

  • Providers must quantify the financial impact of denied and underpaid claims per payer.
  • Selection of scalable managed care contract information systems is recommended.
  • Thorough identification of underpayment issues is essential before settlement discussions.

Conclusions:

  • Proactive financial assessment and strategic use of information systems are vital for healthcare providers.
  • Addressing claim payment problems directly improves financial outcomes and strengthens payer relationships.