Maximizing Provider Revenue with Payer Contract Insight

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares essential insights on how to maximize provider revenue by understanding and leveraging the nuances of payer contracts. Topics covered include addressing prior authorization denials, navigating payer reimbursement policies, ensuring clean claim submissions, and utilizing fee schedules and carve outs. Additionally, Vanessa offers strategies for managing payer plan limitations, timely filing guidelines, and escalation procedures for unresolved reimbursement issues. Listeners are encouraged to harness technology and AI-driven solutions to streamline these processes for enhanced revenue cycle performance.

00:00 Introduction to the Podcast and Host

01:23 Episode Overview: Maximizing Provider Revenue

02:01 Understanding Payer Contracts

03:04 Prior Authorization Guidelines

05:28 Payer Reimbursement Policies

08:08 Clean Claim Requirements

11:34 Carve Outs in Payer Contracts

14:03 Payer Plan Limitations

16:24 Fee Schedules and Contracted Rates

21:29 Requests and Recoupments of Overpayments

23:34 Denials Without Proper Justification

25:10 Timely Filing Guidelines

27:17 Escalating Reimbursement Issues

29:11 Conclusion and Next Steps