Payer Reimbursements & Your Holistic Practice

As you know, there are countless healthcare KPIs (key performance indicators) to review, to monitor over time, and to create goals for improving. We know that the process of pulling reports on so many different KPIs can be overwhelming and confusing, which ultimately makes the process ineffective.

That’s why we love to write various articles that emphasize and explain different metrics to track, their role in your overall operations, and best practices for analyzing them. Today we’re highlighting a financial metric that is often overlooked but which has a tremendous impact on your healthcare revenue cycle: payer reimbursements.

Keep reading to learn more about payer reimbursements, how they play a role in your holistic practice’s revenue cycle, and our top tips for evaluating them.

What Are Payer Reimbursements?

After delivering quality care to patients, the medical coding and billing process begins so that the patient, insurance company, or government program can pay for the services rendered: these are known as payer reimbursements.

Depending on how your holistic practice operates, you might bypass insurance companies or government payer programs like Medicare and opt for the patient to be solely responsible for paying for your services. On the other hand, you might accept insurance or Medicare so that you have a wider pool of patients to attract, in addition to the patient-payer model.

Either way, someone or some entity is paying for the work that you deliver to your patients, and this is why payer reimbursements is a key financial metric to be aware of and track for your holistic practice.

How Do Payer Reimbursements Affect Your Healthcare Revenue Cycle?

Here’s a well-kept secret: your holistic practice needs money to operate, sustain itself, and grow over time. Payer reimbursements affect your healthcare revenue cycle because without consistent, accurate, and timely payments, your practice can’t function.

Therefore, tracking this KPI helps you determine a baseline for your practice’s financial standing and empowers you to know where any discrepancies might be falling through the cracks. Tracking this metric means you’ll have a clear understanding of where, when, and how your holistic practice is getting paid or if there are any areas that need attention. 

Top Tips for Analyzing Your Holistic Practice's Payer Reimbursements

Check out our top tips for analyzing your holistic practice’s payer reimbursements:

Learn Your Payer Reimbursements Through and Through

As the saying goes, knowledge is power. That’s why our first tip for analyzing your practice’s payer reimbursements is to leave no stone unturned and to delve into each case. After all, you don’t know what you don’t know—so do your due diligence to investigate the current standings of your payer reimbursements!

Catching problematic patterns or infrequent inconsistencies in your payments enables you to address them before they continue to cause an unstable financial performance for your practice. Whether it’s a problem caused by inaccurate coding or a payer’s unintentional miscoordination or some other factor, your analysis gives you the power to resolve it.

Plus, with a close eye on your insurance contracts, Medicare billing processes, and patient-payers, you can spot each inaccurate payment as soon as it happens so that it doesn’t spiral into a bigger problem.

Build habits based on best practices, such as:

• Scrub insurance and Medicare claims prior to submission to ensure they’re coded properly
• Keep the lines of communication open with your payer contacts to make sure accurate rates are paid
• In the instance of any underpayment—be it your fault, or the payer’s—follow up and get every dollar you’re owed

Unless you’re applying resources to address reimbursement accuracy, you put your profitability at risk.

Evaluate Your Payer Reimbursements with These Questions

When reviewing this financial metric, ask yourself a few questions to gain a deeper understanding of what’s going on:

• Compared to your payer contracts, whether that’s with your individual patients or with an insurance company or Medicare, are the reimbursements accurate? 
• Which payers are deviating from set rates?
• Are the under or overpayments happening consistently, or sporadically? 

Review your data for the last six months; this is a substantial time period to examine without overwhelming yourself with trends of previous years. Ideally you won’t find any of these issues, but if you do, then you’re able to pinpoint which issues are stemming from where.

Be Conscious of Issues at the Start of the Year

Payer reimbursement issues can happen at any time but can be especially more likely when the new year rolls around in January. Inaccurate reimbursements can be the result of a misaligned fee schedule when payers have yet to update their systems with new codes and updated relative value units (RVUs).

Optimize Your Revenue Cycle with Holistic Billing Services!

Your holistic practice can’t effectively function on an ineffective revenue cycle, which is why examining your payer reimbursements metric is essential for financial success. 

However, if you find yourself overwhelmed with the medical billing process, frequent issues with accurate coding, and general confusion regarding billing insurance companies or Medicare, then you’ll have an even bigger struggle for financial clarity.

Partner with the friendly experts at Holistic Billing Services to handle the complicated responsibility of your medical coding and billing processes! We’ve got billing specialists for your specialty and your success is our success.

Contact us today to learn more!