April 8, 2020

April 08, 2020

Subscribe to Latest Legal News and Analysis

April 07, 2020

Subscribe to Latest Legal News and Analysis

April 06, 2020

Subscribe to Latest Legal News and Analysis

2020 To-Do List: Health Plan Performance Report Card

A turn of the calendar brings us to a new decade, which means new relationships for health care providers or the continuation of long-standing contracts with health plans. It also means new opportunities to evaluate and monitor these relationships, and more importantly, the effectiveness of their performance. If you cannot readily identify key performance metrics for each major health plan relationship, it is time to develop a Payor Report Card in 2020.

Participating in a health plan's network under a contract guarantees nothing. While your contracts may have defined reimbursement rates, sophisticated health plans dilute your expectations through onerous processes, technical requirements and terms that permit them to reduce or delay reimbursement to your providers. Providers need ready access to the necessary information to understand how its relationships perform, including ratios of payment against expected reimbursement, timeliness of payment, reasons for rejected claims or delayed payments, number of appeals needed, denial root causes, amongst many others, as well as an understanding of what levels are acceptable. Measuring and comparing the performance of your relationships will help drive focused operational improvements, identify key terms for future renewals and ultimately protect your revenue expectations.

If you are not actively monitoring contract performance, implementing a Payor Report Card in 2020 will help drive the performance and improvement desired. Polsinelli Healthcare Solutions stands ready to help you develop a Payor Report Card using the elements that are important to your organization to support your goals, initiatives and success.

© Polsinelli PC, Polsinelli LLP in California


About this Author

Jonathan F. Buck Healthcare Attorney Polsinelli Law Firm Los Angeles

Jonathan Buck provides strategic legal, compliance and operational guidance and support to a wide range of health care clients. Jonathan’s practice focuses on advising clients on health care regulation, Managed Care relationships and contract terms, assessment of claims or contract disputes, revenue cycle operations and general business strategies, including identifying operational improvements designed to support provider obligations, comply with applicable law, or to mitigate the impact of commercial payer tactics and claims adjudication practices. He is skilled in...