Contract and Reimbursement Solutions - A Path to Unrealized Revenue

Podcast with Director Robert Roig

As revenue degradation continues to challenge profit margins, understanding and optimizing reimbursement rates is a key component to a healthcare provider’s success. In this Guidehouse On Healthcare podcast episode, Guidehouse Director Robert Roig discusses the pressure that is on managed care leaders today to succeed by negotiating with strategic intent, clear goals, and precise data to support their requests from payers. These leaders also need to provide analytics for contract modeling and accountability to ensure payers are maintaining proper reimbursement that aligns with the negotiated contracts. Roig encourages providers to ask themselves: 

  • Are we able to ensure proper reimbursement is paid?
  • Are we able to effectively model future payer rate changes?

In addition to contract modeling, Roig recommends that each organization reviews zero balance accounts that may have been have overlooked. Examples include when insurance payers apply money to accounts, but the total account value isn’t where it should be. Roig states that when you have a team and the technology that can investigate what’s happening with specific accounts: why they were denied, the opportunities for appeal, the contract language, and how it was applied to the account, you can see if there are payments that still should be made to the hospital provider.

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