Active contract management requires regular monitoring beyond initial negotiation. Track actual payment rates against contracted rates to identify underpayments, monitor denial rates by payer to spot problematic patterns, review days in accounts receivable by payer to identify slow payers, and track volume trends to see if patient loads are shifting. Document any payer practices that […]
Practice changes trigger contract reviews and potential renegotiations. Payers typically have change-of-control clauses allowing them to review or terminate contracts when practices merge or are acquired. Tax ID number changes require new contract execution in most cases. The acquiring entity may need to credential all providers under new arrangements. These transitions should be planned carefully […]
Required documentation varies by service type and payer, but generally includes detailed provider notes describing the service rendered, diagnosis codes supported by clinical findings, medical necessity justification, and any applicable test results or imaging reports. For procedures, operative reports and procedural notes are essential. Time-based services require specific time documentation. Prior authorization approvals must be […]
