Have you ever had a home project in mind and rather than find a trusted professional to take it on, you decide to tackle it yourself? Even though you’ve never done anything like it before, you make the calculation that a bit of your weekend time is worth foregoing a potentially exorbitant price tag. That makes sense. People do it every day. Let’s add a little twist. You’ve done your homework and have a good idea of the supplies you’ll need for this project, so you head out to your favorite home improvement store without ever making a list. Just before you begin stalking the aisles to check off all the invisible little boxes in your mind, you decide to mix it up even further by putting on a blindfold. After about 20 minutes of running into shopping carts, shelving units, and other people, you give up and go home to nurse your bumps. You then decide to just scrap the project altogether out of frustration over this painful debacle.
This scenario sounds ridiculous because it is. Unfortunately, this is a pretty fair comparison to the way many healthcare providers approach payor contracting and credentialing. All too often, they try to handle one of the most laborious and time-consuming specialties (payor contract negotiations) themselves, quickly become overwhelmed and give up before they really get started. This leads providers to settle for the first reimbursement rates offered by payers in healthcare or just ignore contract re-negotiation completely and keep the old rates. Any provider who goes this route is guaranteed to leave a significant amount of money on the table. The good news is, it doesn’t have to be this way.
Because payor contracting is a tedious process that requires many steps, a few more steps, and then multiple follow-up steps; there are experts in the field to take it on for you. They know how to engage with insurance payors who are often more open to mutually beneficial healthcare reimbursement than you might imagine. DataDx has the expertise to undertake all your payor contracting and credentialing negotiations with professionals who’ve worked on both sides of these conversations.
DataDx is a national healthcare company that offers a solution-based platform for private Physician and Dental practices to access services, financial, analytics, and consulting expertise. Among our many roles, we have forged a niche in providing proven healthcare credentialing and contract re-negotiation strategies with the goal of finding fair and achievable medical and dental reimbursement rates. DataDx has built an impressive coalition of healthcare service specialists and relationships within the industry with a mission to advance private practices. Our goal is to equip your practice with all the tools necessary to stay independent, profitable, and build value while maintaining control over the quality of care your patients depend on.
DataDx exists to make your life easier and payor contract negotiations is a major way we do that every day. Our process has been proven to ensure your practice is able to maximize revenue for years to come.
The American healthcare system has been a complex apparatus with evolving regulatory practices and other frequently moving parts since its earliest days. The Affordable Care Act of 2010, for example, facilitated the biggest shift in healthcare policy for many generations before and these ten years since. That said, there are many frequent adjustments made by insurers that are much smaller but still significant. Because of this consistent revamping of health insurance policies and reimbursement rates, providers are often left ill-equipped to enter into payor negotiation and credentialing on their own. The number of focused hours required for proper payor contracting falls well beyond what any patient-oriented provider could spare. That’s where the expert services of an DataDx payor contracting and credentialing specialist become essential.
While payor contracting and credentialing share many similar benefits in terms of maximizing medical or dental insurance reimbursement rates, they are not the same thing. Let’s reflect on their individuality for a moment.
Data enables us to not only tell a story, but also helps to understand past practice patterns and can be used to predict potential reimbursement with the use of modeling.
Data and analytics can be used to develop your strategy with the payor to support negotiation efforts. Accepting a payor proposal without understanding the financial implication can be potentially detrimental to your practice. Using your data and our experienced contract modeling process, we help you to come to the negotiating table, fully equipped.
Once your new practice has gone through the health insurance credentialing process and established a relationship with certain payors, the initial payor contracting phase will begin. Enlisting a professional to take on your new practice contracting makes so much sense because the learning curve is substantial. Each healthcare payor has its own legal jargon and process for negotiating reimbursement rates which means a lot of juggling between insurance companies to understand the fine print. From there, the time will come when you need to engage in contract re-negotiation and this is hands down the most complex job of all. Not only does implementing thorough contract re-negotiation strategies require an immense number of hours but your practice is now fully operational leaving you little time to do more than care for your patients. How much time could you really devote to this process? If the answer is less than full-time for an extended period, you are probably not going to get very far.
Anxious? Don’t be.
No doubt, you are already looking at your calendar to figure out where you can squeeze in a few months for payor contracting or credentialing. Are you freaking out a little bit? Guess what? You don’t have to be. DataDx offers expert health insurance contracting and credentialing specialists who already have relationships with payors and will get the job done faster than anyone could do internally. Allow us to explore our methods further.
DataDx believes the right kind of experience is key to excellence in everything we do. As mentioned previously, our payor contracting specialists have worked in the field for many years and understand the motivation of insurance payors during contract negotiations because they’ve been in their shoes. That kind of insight is priceless when it means maximizing revenue for your practice. How do we do that? We’re glad you asked.
From the time we begin a project, our intention is to learn more about your contracts than you ever cared to know. That process involves a deep dive into your existing contracts to get familiar with the fine print and the legal language used in each agreement. Then a system for contract management is constructed to organize your medical or dental payor information and notify you when future re-negotiation dates are approaching. Next, we begin analyzing mountains of data to uncover which contracts are working well for your practice and those that need improvement. That’s when it’s time to compose a value proposition so we can set your practice apart from your competitors and begin contract re-negotiation for every under-performing payor agreement.
You may be wondering who could possibly know the value of your practice better than you do? Respectfully, we’d answer the data does and that is where our focus lies. DataDx makes a habit of going above and beyond for our clients and part of that is setting you up for realistic outcomes. We analyze every service billed for at least a year to gauge the fairness of your contracts so, if there is room for improvement, we will find it. On the flip side, you may be set on an amount for reimbursement rates for certain services that just aren’t possible depending on your location and/or level of expertise. Our DataDx professionals will make sure you have all the information you need right up front to negotiate the best possible outcome.
As soon as we begin working to advance an effective contract re-negotiation strategy on your behalf, you can count on us to deliver. Our process of negotiating payor contracts goes a little something like this.
Our payor contracting and credentialing approach is so thorough because we know how important it is to get it done right the first time. Once we organize all your payor contract information into your own customized matrix, you should never be caught flat-footed with a costly contract auto-renewal again. When future health insurance contract re-negotiations roll around again, DataDx will be there to pick up where we left off and make sure your practice is being fairly compensated for the good care you offer your patients.
Payor contracting and credentialing is an incredibly precise venture and you are better off to never approach it like a good old-fashioned ‘weekend warrior’ project for your home. It is a long and laborious job to pick apart, analyze, and organize all your insurance payor contracts and DataDx’s process is second to none. Our experts will set you up for success so that you never inadvertently miss out on money that should be in your pocket rather than your payors’. When you become a member of the DataDx family, rest easy because your focus can stay where it matters most, on your patients. Why do we do all this? Because we care about the people who provide healthcare services as much as those who need them. That’s why we’re here.