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	<title>reimbursement Archives - The Midland Group</title>
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		<title>7 Ways To Understand Your Third-Party Payer Contract</title>
		<link>https://tes.midlandgroup.com/blog/2021/01/26/7-ways-to-understand-your-third-party-payer-contract/</link>
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		<pubDate>Wed, 27 Jan 2021 01:54:06 +0000</pubDate>
				<category><![CDATA[Self-Pay Patients]]></category>
		<category><![CDATA[clean claims]]></category>
		<category><![CDATA[covid]]></category>
		<category><![CDATA[golden rule]]></category>
		<category><![CDATA[handling third-party claims]]></category>
		<category><![CDATA[liability claims]]></category>
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		<category><![CDATA[medical billing vendor]]></category>
		<category><![CDATA[medical third party billing]]></category>
		<category><![CDATA[reimbursement]]></category>
		<category><![CDATA[revenue cycle management]]></category>
		<category><![CDATA[the golden rule]]></category>
		<category><![CDATA[the midland group]]></category>
		<category><![CDATA[third-party]]></category>
		<category><![CDATA[third-party billing]]></category>
		<category><![CDATA[third-party liability claims]]></category>
		<category><![CDATA[third-party payers]]></category>
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		<category><![CDATA[what's the golden rule of third-party billing?]]></category>
		<guid isPermaLink="false">https://tes.midlandgroup.com/?p=6929</guid>

					<description><![CDATA[<p>The Important of Understanding Third-Party Payer Contracts In the context of third-party billing, we believe that it is extremely important for providers to obtain reimbursement for their services within a reasonable amount of time. We also understand the necessity for third-party payers to have the chance to thoroughly scrutinize their responsibility in the payment of&#8230;</p>
<p>The post <a href="https://tes.midlandgroup.com/blog/2021/01/26/7-ways-to-understand-your-third-party-payer-contract/">7 Ways To Understand Your Third-Party Payer Contract</a> appeared first on <a href="https://tes.midlandgroup.com">The Midland Group</a>.</p>
]]></description>
										<content:encoded><![CDATA[<h2><span style="font-weight: 400;">The Important of Understanding Third-Party Payer Contracts</span></h2>
<p><span style="font-weight: 400;">In the context of third-party billing, we believe that it is extremely important for providers to obtain reimbursement for their services within a reasonable amount of time. We also understand the necessity for <a href="https://www.bankrate.com/glossary/t/third-party-payer/#:~:text=What%20is%20a%20third%2Dparty,(HMOs)%2C%20and%20employers.">third-party payers</a> to have the chance to thoroughly scrutinize their responsibility in the payment of the claim and decide if the services provided are truly necessary.</span></p>
<p><span style="font-weight: 400;">According to the golden rule for third-party billing, there is no obligation to guarantee coverage or any other liability in the event that coverage lapses due to the third party’s failure to submit payment by the due date. Simply put, if a charge is not documented, you can not bill for it. When it comes to private payers, it is important to understand your third-party payer contract so as to avoid any lapses in reimbursement. </span></p>
<h2><span style="font-weight: 400;">Seven Tips To Understand Your Third-Party Payer Contract</span><b></b></h2>
<ul>
<li aria-level="1"><b>Know your rights. </b><span style="font-weight: 400;">To avoid delays in payments that would cost you, be sure that you understand your rights when speaking about a contract and request a better explanation of the insurance provider’s payment schedule language if you don’t understand. </span></li>
</ul>
<ul>
<li aria-level="1"><b>Define payment period for clean claims. </b><span style="font-weight: 400;">Always make sure that there is a clause that holds the health plan responsible for paying any claims within a specific period of time. Without this clause, there is no obligation on the part of the health plan to pay the claim within a reasonable amount of time. During this step, make sure you ask for clarification on what a payer deems as a clean claim and if there are additional requests for information that is considered reasonable. </span></li>
</ul>
<ul>
<li aria-level="1"><b>Define payment period for unclean claims. </b><span style="font-weight: 400;">Make sure that you have a firm definition of the timeframe in which the health plan can return a claim as unclean. This will help avoid the health plan from holding unclean claims to delay any payments. The contract should also specify how much time will be allowed to review this additional information before any payments are made. </span></li>
</ul>
<ul>
<li aria-level="1"><b>Address claims considered “not to file.” </b><span style="font-weight: 400;">Your contract should require the health plan to acknowledge receipt of an electronic claim within 24 hours of receiving it. Failure to be acknowledged, the health plan should be contracted and the claim resubmitted. If the health plan states that they never received a claim, you will be able to provide documentation of the original file date and require that they pay within the guidelines that were stated in the contract. </span></li>
</ul>
<ul>
<li aria-level="1"><b>Identify penalties. </b><span style="font-weight: 400;">List what penalties are to be addressed when the health plan does not pay according to prompt-payment guidelines. State that participating provider discounts be waived and the health plan will be liable for 100% of billed charges plus interest. If not attainable, the health plan should be obligated for payment of the claim plus pre-set interest. </span></li>
</ul>
<ul>
<li aria-level="1"><b>Protect your payment. </b><span style="font-weight: 400;">Your contract should specify that all payments made are considered final unless the provider receives a written request within a specified period of time after receipt of payment. </span></li>
<li aria-level="1"><b>Perform regular reviews. </b><span style="font-weight: 400;">Always be sure to review your contracts regularly as most contracts have an automatic annual renewal. Check with your state regarding prompt-payment laws and request appropriate addendums to your contract before renewing. </span></li>
</ul>
<h3><span style="font-weight: 400;">Now What?</span></h3>
<p><span style="font-weight: 400;">Providers are becoming better educated in the reimbursement process and state legislation. That’s why it’s crucial that you work with your third-party payers to help negotiate fair and equitable contracts. </span>The Midland Group specializes in Third-Party Billing for Healthcare. As a <a href="https://tes.midlandgroup.com/hospital-revenue-cycle-solutions/">third-party billing specialist</a>, The Midland Group will submit, process, and collect all <a href="https://tes.midlandgroup.com/blog/identify-submit-third-party-liabilities-claim/">third-party liability claims</a> necessary to collect as much revenue as possible for the hospital and to reduce the patient’s personal financial burden. Our trained medical billing professionals can help you optimize your billing system to increase revenue and improve the patient experience. <a href="/accident-reimbursement-assessment">Book</a> your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​</p>
<p>The post <a href="https://tes.midlandgroup.com/blog/2021/01/26/7-ways-to-understand-your-third-party-payer-contract/">7 Ways To Understand Your Third-Party Payer Contract</a> appeared first on <a href="https://tes.midlandgroup.com">The Midland Group</a>.</p>
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		<title>Measuring the Patient Financial Experience</title>
		<link>https://tes.midlandgroup.com/blog/2020/05/18/measuring-the-patient-financial-experience/</link>
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		<pubDate>Mon, 18 May 2020 20:46:04 +0000</pubDate>
				<category><![CDATA[Collections]]></category>
		<category><![CDATA[Revenue Cycle Management]]></category>
		<category><![CDATA[Self-Pay Patients]]></category>
		<category><![CDATA[financial customer experience]]></category>
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		<category><![CDATA[reimbursement]]></category>
		<category><![CDATA[revenue cycle]]></category>
		<category><![CDATA[revenue cycle vendor]]></category>
		<guid isPermaLink="false">https://tes.midlandgroup.com/?p=3921</guid>

					<description><![CDATA[<p>The post <a href="https://tes.midlandgroup.com/blog/2020/05/18/measuring-the-patient-financial-experience/">Measuring the Patient Financial Experience</a> appeared first on <a href="https://tes.midlandgroup.com">The Midland Group</a>.</p>
]]></description>
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			<p><span style="font-weight: 400;">Within the last few years, hospitals nationwide have witnessed the rapid rise of the healthcare consumer. Replacing traditional third-party organizations as </span><a href="https://nrchealth.com/wp-content/uploads/2017/05/The-New-Payer-White-Paper_V8.pdf"><span style="font-weight: 400;">the primary payer in healthcare</span></a><span style="font-weight: 400;">, patients have quickly become the new focal point of healthcare finance. As such, hospitals have quickly realized that engaging this new payer segment requires a different approach than what has been done in years past. After all, the rise in patient financial responsibility has made healthcare bills more difficult for patients to pay, and thus harder for hospitals to collect.</span></p>
<p><span style="font-weight: 400;">In addition to posing a new set of revenue cycle challenges, the recent increase in healthcare’s out-of-pocket costs have also resulted in “</span><a href="https://nrchealth.com/wp-content/uploads/2017/05/The-New-Payer-White-Paper_V8.pdf"><span style="font-weight: 400;">consumers demand[ing] more from healthcare organizations</span></a><span style="font-weight: 400;">.” In fact, according to an </span><a href="https://nrchealth.com/wp-content/uploads/2017/05/The-New-Payer-White-Paper_V8.pdf"><span style="font-weight: 400;">NRC Health report</span></a><span style="font-weight: 400;">, “once an afterthought in a system built around physicians and payers, consumers are now better informed, less patient, and laser-focused on quality and cost.” In response to this development, </span><span style="font-weight: 400;">most hospitals have increased their efforts to ensure an efficient financial process for their patients. Yet, while these steps certainly aim to improve the overall patient financial experience, many facilities struggle to establish a baseline to measure how well their efforts line up with the patients’ </span><i><span style="font-weight: 400;">actual</span></i><span style="font-weight: 400;"> experiences. Ultimately, it is this experience that forms a patient’s perceived notion of a facility’s quality of care, which then determines how likely a patient is to pay their bills and be loyal to a facility. </span></p>
<p><span style="font-weight: 400;">While certainly not impossible, there are few things that are harder to quantify than the overall patient financial experience. </span><span style="font-weight: 400;">However, </span><a href="https://www.hfma.org/courses/managing-and-measuring-the-patient-financial-experience.html"><span style="font-weight: 400;">experts at HFMA </span></a><span style="font-weight: 400;">found that “ [a patient’s] ability (or inability) to understand and comfortably pay medical bills often carries as much weight as the overall quality of care received.” Thus, </span><span style="font-weight: 400;">investing in the initiative to measure patients’ financial experiences is critical for any hospital to thrive in this age of the healthcare consumer. </span><span style="font-weight: 400;">So how can hospitals gauge the effectiveness of their financial processes and accurately measure their patient’s experiences? Here are few key indicators to look out for:</span></p>
<h1><b>Patient Engagement Metrics</b></h1>
<p><span style="font-weight: 400;">When trying to gauge the overall patient experience, facilities can start by analyzing patient engagement metrics. For example, keep track of electronic bill open rates, call received rates, and mail return rates. Pay attention to when those rates are highest &#8211; is it on a certain time of day, or day of the week? In addition, how many financial communication efforts were made following up with patient visits? How many bills, on average, does it take before your facility receives payment? Other metrics may include percentage of click-through rates, average point-of-service collection success, call abandonment rates, and percentage of first bills paid.</span></p>
<p><span style="font-weight: 400;">Understanding these standards for patient engagement can empower facilities to get a better analysis of their financial communication efforts. After all,</span><span style="font-weight: 400;"> p</span><a href="https://www.beckershospitalreview.com/finance/executive-briefing-how-billing-and-collections-impact-the-patient-and-what-providers-can-do-to-protect-their-bottom-line.html"><span style="font-weight: 400;">atients who understand their bills and financial options are more likely to respond to a facility’s correspondence efforts, which reduces the rate of financial overwhelm</span></a><span style="font-weight: 400;">. In this way, patient engagement metrics may indicate the state of facilities’ patient financial experience. In response, monitoring such metrics can help facilities tweak their billing efforts to better cater to the needs of their patients and improve the quality of their financial experience. </span></p>
<h1><b>Patient Reviews</b></h1>
<p><span style="font-weight: 400;">In this age of consumerism, reviews have transformed the way people make decisions and form opinions about certain products and services. The same is true of healthcare. Often, the interactions that your patients and their families experience in healthcare facilities may manifest into online reviews and word-of-mouth.</span><span style="font-weight: 400;"> As such, patients&#8217; <em>perceived</em> quality of their overall experience determines whether their reviews are positive or negative. Keep in</span><span style="font-weight: 400;"> mind </span><span style="font-weight: 400;">that the revenue cycle process spans from first impression processes, such as registration, all the way through the end of care, such as billing. According to </span><a href="https://www.reviewtrackers.com/reports/online-reviews-survey/"><span style="font-weight: 400;">ReviewTrackers</span></a><span style="font-weight: 400;">, </span><span style="font-weight: 400;">people are increasingly more likely to leave reviews after a patient experience. What’s more, NRC Health found that “patients are using reviews to either accept or reject a new relationship with a provider,” with 37% of patients utilizing online reviews as their first step in a healthcare purchasing decision. Both of these metrics show the importance of  monitoring reviews. Not only do reviews provide valuable insights regarding a facility&#8217;s patient experiences, they also allow management to address any areas of improvement through future operational changes. That being said, keep in mind that as a healthcare facility, responding to feedback may trigger a <span class="il">HIPAA</span> violation, so simply monitoring online reviews to glean information is often the best course of action. </span></p>
<h1><b>Patient Feedback</b></h1>
<p><span style="font-weight: 400;">Even without the supplementation of digital metrics, general observation can also provide valuable indication of patients’ financial experiences, though perhaps more qualitative than quantitative. Every day, patients give verbal and non-verbal feedback. From smiling faces to worried complaints to angry expressions, patients’ demeanors can indicate how they are feeling about certain processes. That’s why it is crucial for your front-line financial staff to keep tabs on general patient trends and relay such information for your hospital leadership to address, such as during monthly meetings or through systemized reports. Another way hospitals can keep track of patient feedback is by implementing various research methods, such as surveys, focus groups, and interviews. Keep in mind that while a single feedback isn’t directly indicative of an overall problem, enough feedback of similar kinds can provide valuable context for what your hospital can address and improve on. </span></p>
<p>&nbsp;</p>
<h1><b>Now What?</b></h1>
<p><span style="font-weight: 400;">According to a </span><a href="https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-dchs-the-value-of-patient-experience.pdf"><span style="font-weight: 400;">study conducted by Deloitte</span></a><span style="font-weight: 400;">, hospitals with better patient experiences consistently see “larger net margins relative to hospitals with low satisfaction scores”, even after accounting for factors such as “hospital size, urban/rural location, ownership type, teaching status, and being part of a system, case and payer mix, and local market HRR characteristics.” With such indicative correlation, it’s no wonder hospitals constantly seek to improve various operational processes to increase the quality of their patient experiences, especially on the financial aspect. Howver, while these are all great starting points, it is also important</span><span style="font-weight: 400;"> for facilities to measure how patients are responding to the changes implemented. Getting started with tracking patient engagement, being attentive to reviews, and collecting feedback are all great ways to gather insights and quantify the patient financial experience. Once enough data is gathered, facilities will find that it becomes easier to recognize areas of improvements and make changes where it is most needed. By doing so, facilities will increase the likelihood of patient loyalty, increased revenue, and better patient-provider relationships.</span></p>
<p>&nbsp;</p>
<h1><b>About The Midland Group</b></h1>
<p><span style="font-weight: 400;">The Midland Group&#8217;s  </span><a href="/hospital-revenue-cycle-solutions/one-touch-solution-self-pay-cash-flow/"><span style="font-weight: 400;">One Patient. One Touch. One Solution</span><b><img src="https://s.w.org/images/core/emoji/15.0.3/72x72/2122.png" alt="™" class="wp-smiley" style="height: 1em; max-height: 1em;" /></b></a> <span style="font-weight: 400;">system equips patient access representatives with the personalized expertise to ensure that every patient has a positive financial experience. Here at The Midland Group, we care about the people you serve. Our on-site staff supports your billing office and hospital registration to educate patients on their financial options. We offer a variety of payment options that allow patients to settle their bill, which increases upfront revenue and earns patient trust. Our comprehensive system has been proven to reduce defaults, increase revenue, and improve the level of patient satisfaction of your hospital.</span><a href="/contact/"><span style="font-weight: 400;"> Contact us </span></a><span style="font-weight: 400;">and discover how our patient access services can help your hospital improve patient experience and increase revenue.</span></p>

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<p>The post <a href="https://tes.midlandgroup.com/blog/2020/05/18/measuring-the-patient-financial-experience/">Measuring the Patient Financial Experience</a> appeared first on <a href="https://tes.midlandgroup.com">The Midland Group</a>.</p>
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