Q&A: Monitoring payer updates

Q: How can we ensure key staff are kept up to date on commercial payer changes?

A: One of the most effective ways that I have seen this accomplished was through a regular managed care update meeting, held either monthly or quarterly. The meetings were hosted by the contracting/managed care department and were held onsite and with a WebEx connection for participants located in other areas of the facility’s campus. About two weeks prior to the meeting, the department sent out a request for agenda items to all the participants, who, in turn, would submit any issues or questions they had regarding any of our contracted payers or managed care organizations.

During the meeting, each of the items was discussed in detail and either resolved during the meeting or carried forward as action items. The managed care department also discussed any impending or recently concluded negotiations, terminations, and division of financial responsibility (DOFR) updates or issues and reviewed any upcoming payer updates. The forum works best if it includes participants from all aspects of the revenue cycle, including admitting, business office, coding, chargemaster, revenue integrity, pharmacy analytics, denials management team, case management, and the education department. If the agenda items are submitted in advance, it gives the contracting department time to research the issue and provide an answer or solution during the meeting.

For more information, see The Essential Guide to Healthcare Payer Contracting.