Billing & Payor Relations
Healthcare systems face the daily pressure to provide excellent patient care while concurrently maintaining the health and financial viability of their organization.
Simple Solution knows that open and proactive communication with payors is critical to maintaining stable revenue and preparing for future reimbursement models
- Informed Market Adjustment: A strong regional home health player became a preferred partner for a hospital and progressive ACO. Simple Solution performed a comprehensive payor contract audit, with emphasis on compatibility to discharged patient mix from the system. Gaps in contracting were addressed by our team with each payor.
- Innovative Reimbursement: While designing an Emergency Department Intervention Program for emergency, acute and post-acute providers, Simple Solution simultaneously initiated conversation with a large commercial payor to modify existing payor templated and reimbursement parameters. This resulted in agreed alterations of patient rules, existing contract codes and payments prior to the launch of the pilot.
- Education: A national hospice provider is growing rapidly though acquisition. Simple Solution has been tasked with all new and transition contract work on behalf of the organization. Tools, flow sheets and education have been developed to assist new and existing staff with understanding the nuances of preauthorization, billing protocols and contract demands.