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Category: Contracting

  • What is Contract Management?

    What is Contract Management?

    Effective Management of Healthcare Contracts

    Contract management plans, organizes, and executes the activities required to manage the contract from start to finish. The role of this department is to make sure that all the processes are followed and no hiccups are encountered along the way. Contract administration on the other hand is responsible for day-to-day operations and running a successful business under the contract framework. This includes maintaining effective contracts in place, implementing operational procedures, monitoring performance, tracking costs as well as managing human resources and technology needs. Contract management vs contract administration can look like similar tasks at first glance but they are actually very different in practice. This article will help you grasp why so.

    What is contract management?

    Contract management is the process of managing contracts from inception to closure. This process involves a lot of planning to ensure that activities are correctly executed, risks are mitigated, and deadlines are met. In essence, the role of the contract manager is to ensure that the project stays on track and isn’t derailed by unexpected occurrences. It is the role of the contract manager to coordinate the work of internal and external personnel, ensure that all legal documents, such as contracts and agreements, are up to date. The contract manager is responsible for obtaining the necessary approvals, such as the approval of the owner, the sponsor, and the customer. The contract manager is responsible for ensuring that the terms and conditions of the contract are followed.

    What is contract administration?

    Contract administration is the process of managing a contract from start to finish. This process involves a lot of planning to ensure that activities are correctly executed, risks are mitigated, and deadlines are met. In essence, the role of the contract manager is to ensure that the project stays on track and isn’t derailed by unexpected occurrences. It is the role of the contract manager to coordinate the work of internal and external personnel, ensure that all legal documents, such as contracts and agreements, are up to date. The contract manager is responsible for obtaining the necessary approvals, such as the approval of the owner, the sponsor, and the customer. The contract manager is responsible for ensuring that the terms and conditions of the contract are followed.

    Differences between Contract Management and Contract Administration

    – Focus – Generally, while preparing a bid, both the terms and conditions in the bid document and the bid document itself is the same. However, the responsibility of the contract manager and the contract administrator gets split once the contract is signed. The contract manager is responsible for ensuring the terms and conditions in the signed contract are followed, whereas the contract administrator is responsible for the execution of the contract from start to finish. – Scope – The responsibilities of the contract manager and the contract administrator will vary depending on the nature of the contract. For example, if you have a contract to build a software, contract manager will be responsible for managing the design of the software while contract administrator will be in charge of executing the project. – Composition – The contract manager and contract administrator roles are often combined in the form of a project manager. In such a case, the project manager manages the overall project and both contract management and contract administration roles are combined in this person.

    Key Takeaway

    The roles of the contract manager and the contract administrator can be distinguished based on their focus and scope, as well as the composition of their roles in a contract. In essence, contract management is responsible for ensuring that the project stays on track and gets delivered, whereas contract administration is responsible for the day-to-day operations under the contract framework. It is advisable to hire a professional team like WWS for efficient contract management and executions of the contracts.
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  • 4 Ways to Evaluate and Negotiate Reimbursement Specific to Your Practice

    4 Ways to Evaluate and Negotiate Reimbursement Specific to Your Practice

    When it comes to negotiating reimbursement with your payers, it can feel like a game of whack-a-mole. You know the drill: You send in your bill or claim, and then wait for a response. After months or even years of waiting, you get nothing in return except frustration. Negotiating reimbursement with your payers is a process that requires patience and persistence. To keep things moving and minimize the time between negotiations, you need to streamline the process and use specific tactics to speed up negotiations, such as asking for a negotiation timeline before finalizing any offer.

    Understand reimbursement negotiation basics

    Before we start talking about specific tactics, let’s take a step back and understand the big picture of reimbursement negotiation. When working with payers, your goal is to negotiate a specific price for your services. Certain factors affect how much you can charge for your services. For example, factors like your practice size, the type of services offered, the geographic location of your patients, and your level of experience or training can all affect your reimbursement rates. Once you’re able to set your price, you have to convince your payer to agree to it, which is no easy task. For most practices, there are several financial barriers that prevent you from signing a written agreement with a payer such as long payment cycles, long-term debts, or an unwillingness to contract.

    Streamline processes and create a standard forms/templates

    Once you start getting reimbursements, you’ll notice that the process of negotiating with payers is really time-intensive and repetitive. To streamline the process, start creating a standard form/template for all communication with payers. Start with a letter. In this letter, clearly define your business and explain why you’re owed the money. Then, add a few paragraphs about the process for negotiating with the payer. This is important to keep with you throughout the negotiation process. Once you have a template, you can apply it to all your communications with payers. Using a template will reduce the time spent on every single negotiation, saving you precious time and energy that you can use to focus on more important things.  Maximize Your Payer Network – Get In Touch With A Contracting Expert In Your Region

    Ask for a timeline to negotiate

    In the beginning, it’s important to keep the payer in the know about the status of negotiations. Once you’re in the negotiation process, you have to be proactive. Be aggressive and keep communicating with the payer to keep them in the loop. You can do this by updating the payer on your negotiation timeline. Be transparent, and explain to the payer why you need a certain amount of time to get the deal done. For example, if your payer is seeking a discount as part of the negotiation, be upfront and explain why this discount is important. It could be because the payer has low-income patients that need discounted services, or it could be because the payer has a specific type of insurance that may not cover the full cost of your services.

    Ask for help or assistance

    In the beginning, you may be inclined to handle every negotiation on your own. This can be a mistake. Different payers have different negotiation techniques, and some practices may even be more aggressive than others. If you’re not sure how to negotiate with a particular payer, you can always turn to your peers in the healthcare industry. For example, if you have a particularly aggressive payer, ask your fellow medical billers where they’ve negotiated with the payer and what they did. You can also consider Shortening the process by partnering with WWS the contracting experts for Ancillary providers nationwide.

    Use data to make an argument

    There are many different ways you can use data to make your case during a negotiation. For example, you can explain why you have a high number of patients that are uninsured or under-insured. You can explain why your practice is unique and not easily replicated. You can explain the impact of your services on the patient’s health. In each case, you’ll want to make sure that you’re using data to show the full picture of your practice and how your services impact the patient’s health. You want to use data to support your claims for reimbursement, not as an excuse for why you don’t want to negotiate a lower rate.

    CONTRACTING COMPETITIVE EDGE – WWS
    • Expertise and experience in the field of DMEPOS of more than 190 years have resulted in us being one of a kind organization. We have discovered simple formulas for handling complex DME activities through this in-depth understanding.
    • As part of our holistic approach, we optimize best practices for growth and quality negotiations, tailored to position your organization within a highly competitive and rapidly evolving market. We know what it takes to ensure our providers deliver results.
  • Self-Credentialing and Contracting Pitfalls to Avoid to Help your Practice Grow

    Self-Credentialing and Contracting Pitfalls to Avoid to Help your Practice Grow

    Best practices for ensuring successful credentialing and contracting include:

    Involving healthcare professionals throughout the process by providing instruction on the selection of action words and phrases, the process for credentialing, and the importance of the documentation. If a provider is not familiar with the documentation requirements, then he or she may be less likely to document appropriately and will more likely be denied by the patient’s health plan.

    Identify the range of credentials or certifications currently in use across your clinic/hospital. While this may be obvious, knowing the “whose credentials” prevent future credentialing problems.

    Determining who currently handles the credentialing process. This can be the person responsible for hiring or managing a staff person.

    Ensuring current or past credentials are up to date.

    Developing an integrated and efficient credentialing, contracting, and contracting for services process with the provider or supplier for specific services

    Finding ways to streamline this process in order to reduce time and costs

    Consistently enforcing the necessary documentation and documentation procedures, which should be well-documented, up-to-date, and consistent

    Ensuring that the process and documentation support the success of the company’s mission

    • Take the time to look at self-credentialing from a business perspective.
    • Build in a contingency plan for credentialing and contracting.
    • Use the same due diligence process for self-credentialing and contracting.
    • Make sure the process is designed to be actionable and measurable.
    • Make the process easy and efficient to follow.
    • Set up a system to capture the data.
    • Make sure the process is appropriate to the client.
    Keep Exploring The Current Best Practices in the Industry

    Successful credentialing and contracting practices always start with skills assessments and workforce needs analyses. This is an important part of strategic planning for practices looking to expand their bandwidth, establishment or industry. It is a critical first step in understanding the needs to be met in the industry and appropriation to be developed and deployed.

  • Things you should know before signing a contract

    Things you should know before signing a contract

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    You should know before signing a Contract with insurance companies that are dense with legal and financial information that primary care physicians may find difficult to comprehend and keep track of. Most insurance companies hope for this, and they frequently create contracts that are so densely packed with technical terminology that simply understanding them takes a long time. Regardless, you should make an effort and devote the time necessary to understand your strategy.

    In general, insurance contracts should pay you roughly 12% more, but the contract’s complicated verbiage is designed to make the process more difficult and deceive you into signing a contract with lower rates. When this happens, you should open up the topic for renegotiation of your contract. And, if you’re not careful, you might not get the rates you deserve. There are several guidelines to follow in order to successfully renegotiate a contract, and you should also know when to reject a contract.

    Health plan insurance strategy

    Knowing more about the health plan given by the insurance providers is the most crucial thing to do before you decide to go through the contract or if you need to check if you should be renegotiating. This phase is critical because it allows you to determine whether or not your practice is eligible for the plan and how well it fits the health plan. You should go to your health plan’s website or contact them for information on additional healthcare providers, such as primary care physicians like yourself or hospitals and surgery centers. Not only does this assist you in determining whether your service is covered by the health plan, but it also informs you of your importance to the health plan.

    Contract renegotiation

    If you believe that the initial contract is not providing you with what you are worth, it may be time to renegotiate. While renegotiating the terms of your contract, be wary of the following deal breakers, which may appear innocuous enough but are actually set purely for the benefit of the insurance provider. If these are the terms of your initial contract, set up a meeting for contract renegotiation as soon as possible because you are not being treated fairly.

    • The insurance provider does not need our signature to change the terms of the contract. This is a big no-no in any field, not just insurance, because you have no say over any future changes to the contract.
    • The health plan may change significantly, and you will be required to follow those changes because you waive your right to be consulted about these changes.
    • You do not have access to all applicable fees.
    • The contract’s definitions of who has access to the services are unclear and ambiguous.
    • According to your contract, you are not permitted to set any parameters or limits for your practice. This restriction on your independence is a deal breaker because you will always need approval from your insurance providers.

    These are the most prevalent deal breakers in contracts that are purely for the advantage of the insurance company. In general, if your contract is littered with confusing phrases that are difficult to keep track of, as well as provisions that take away your authority over most topics, it isn’t right for you.

    Before you sign a contract, speak with one of our professionals at WWS, who can guide you in establishing insurance contracts that are both business-centric and profit-oriented.

     

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