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The Importance of Payment Compliance Analysis

It is extremely important for healthcare providers to actively assess and monitor their payer compliance. Effectively managing payer compliance involves performing payment compliance analysis and leveraging payer relationships to resolve issues.  This blog will focus on the keys to effectively conducting payment compliance analysis.    

What Is Payment Compliance Analysis?

Payment compliance analysis is like putting on a detective hat and investigating your payment data to evaluate payment trends (e.g., payment accuracy, delays, and denials) and detect payment errors and issues. It helps healthcare providers identify trends related to key payment metrics such as A/R aging over 90 days, first pass denial and underpayment rates.   Drilling down into more detail once an issue is detected is important in order to have concrete case examples that can be shared with Payers. At a minimum, payers will need to conduct their own research using case examples in order to validate the issue and research the root cause.

Improving Payment Accuracy and Timeliness

Payment compliance analysis doesn't just identify problem areas; it also provides the detail and insight needed to identify and address the root cause of these problem areas. Armed with this information, providers can have more productive conversations with their payers and effectively them more accountable for the payment errors and delays.

Enhancing the Conversation with Payer Scorecards

Imagine a report card for payers—that's a payer scorecard. It's like a cheat sheet showing how well payers do in areas like processing claims. Leveraging the data and insight gained through payment compliance analysis, providers should create payer scorecards that compare payers against one another and to industry benchmarks in order to highlight areas that need to be addressed in order to enhance payment compliance.  There are industry tools and organizations (e.g., HFMA) that have helpful resources to support the creation of payer scorecards.  By using these scorecards, providers can enhance their conversation with a payer that demonstrates a pattern of poor payment compliance.

Final Thoughts

In a nutshell, analyzing and actively monitoring payment compliance is a high-value process for hospitals.  Without the data and insights from this analysis, hospitals stand to lose significant revenue and lack the leverage needed to effectively address payment delays and errors with their payers.  Discover how payment compliance analysis can be a game-changer for your revenue stream with Climb Healthcare Consulting. Take the first step towards improving your payment compliance by booking a complimentary consultation with us!

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