Biomedical subjects
Publications and source records attributed to Terri Welter.
Silent payers can be difficult to detect, and their payment practices can drastically affect a hospital's bottom line. An audit approach to payment problems can uncover silent PPO activity. Information from the audit can be used to negotiate a settlement for the unpaid amount. Contracts with payers should include specific language that protects against silent PPO activity.
In response to poor payment performance by health plans, providers are realizing that managed care contracts require systematic, ongoing management rather than a periodic focus. An effective managed care cycle that encompasses strategy development, implementation of the strategy through contracting and operations, and monitoring of contract performance can accomplish this needed oversight. Each phase requires specialized management tools, skills, and staff. Because of the importance of managed care to the provider's financial viability, a wide range of persons should be involved in the managed care cycle, including the board of directors, business office staff, senior management, and finance staff. As providers embrace a more structured approach to managed care, they will increase their chances of receiving accurate contracted payments.
Know the warning signs that indicate your practice is losing money through underpayments. A constellation of factors combine to conceal financial drainage from third-party payers--but the alert administrator can spot and reverse the problem.