Can Your Referral Providers Provide Payer Insight Ahead Of Contract Negotiations?

Congratulations, you have a healthcare referral partner. Now you can sit back and watch the waiting room fill up with new patients.

Unfortunately, healthcare collaboration is not achieved without planning and communication. Therefore, as you begin a relationship with your referral partner – or even seek to strengthen a long-standing but low-volume referral partnership – you might also think about collaboration possibilities across all levels of the patient experience – from access and billing to denied claim resolution.

There is not better time to assess your communication strategy then during contract negotiations with your payers. Healthcare providers strive to collaborate closely on the clinical aspects of the referral partnership. However, extending your collaboration into conversations about patient access, payer performance and reimbursement can facilitate a better working relationship, increased value to your patients and improvement of the overall payer network.

In the minimum, better communication between referral partners can facilitate prompt, accurate referrals in full compliance with payer-specific treatment guidelines. However, if payers do not respond consistently to treatment requests, the payer processes can be nothing more than drain time from more important care demands. You may also want to discuss with referral partners payer performance on such critical metrics as electronic remittance transparency, processing time frames and overall denial rates. This information might be critical in negotiating reimbursement terms that make the payer relationship sustainable.

One way to achieve ongoing communication about payer performance is to develop a referral partner communication plan that involves your revenue cycle team. Such a communication plan can involve scheduled, periodic inquiries to referral staff about revenue cycle issues, such as payer-specific billing issues and impediments to specialty-care access. A referral partner communication plan prompts lines of communication which might have remained dormant (such as billing manager-to-billing manager communications) and makes for an overall better working relationship between organizations.

Review the following Referral Partner Communication which is meant to be used in advance of contract negotiations. This was designed for orthopedic practices but you can easily customize this letter to suit your specialty and communication goals. Make sure to assign one of your staff to monitor referral partner responses, respond promptly to responses and/or requests and make related updates to your payer management system to reflect any payer-guidance obtained from your referral partner.

Sample Referral Partner Letter For Orthopedic Practices

Dear Referral Partner,

Thank you for your history of referrals to our orthopedic practice. We are constantly seeking to improve our coordination of care practices and we hope that your patients have been well served by our clinical partnership.

We would like to keep you informed regarding our efforts to improve prompt orthopedic access and services to our mutual patients served by (PAYER). In order to prepare for our yearly contract renegotiation with (Payer), we have a number of specific objectives and are currently assessing overall payer performance. As part of this review, we are seeking payer performance assessments from local healthcare organizations and any input related to access to orthopedic care. We would appreciate any information you can provide regarding the following:

(Customize the following bullet points to your specific needs)

Approximate number of patients and/or average monthly claim volume submission to (Payer).

Average days outstanding for this Payer and whether late payments include voluntary interest and/or late payment penalties.

Payer operational procedures which may impact access to orthopedic care.

We have identified the following procedure/diagnoses codes which have been associated with claims delays and/or denials by the payer. To assist with our denial management improvement, we request any information your office can provide regarding these codes and if you have obtained any coding and /or clinical guidance from the payer related to these codes.

Thank you in advance for any assistance you can provide regarding these items. Again, we are committed to providing your patients with the highest care possible and want to ensure that patient satisfaction remains high. If you wish to discuss any matter, please contact our office. We look forward to hearing from you.

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