EXPLORINGSUCCESSFUL STRATEGIESTO CHANGEPAYERBEHAVIOR

The payer-provider relationship needs transparency from both sides and balance among everyone?s motivating factors. After that, provider organizations can benefit from taking these three steps to prepare to change payer behavior

- Get your housein order.?It?s almost impossible to establish a payer strategy if the staff is not on board and is following the signals from the payer?s influence,?such as not appealing any but the most obvious denials, Mr Ahlmer said

- Hold accountabilitiesand enforceyour rights.Exercise the rights available in contracts and remember that it?s ok to get a denial and push for the right status, such as inpatient versus outpatient ?What are other options beyond the individual transaction, because we can get buried in the day-to-day transactions??Mr Ahlmer asked

- Escalatepayer issuesto changepayer behaviors. Using joint operating committees or executive escalation can help when other tactics fail or using arbitration and even lawsuits.

3 CorroHealth has helped numerous health systems achieve sustained results in changing payer behavior

For example, three midwestern health systems in the same market were facing an unsustainable financial situation due to adverse payer relationships. Attempts to remove friction in the authorization and denials process had failed and reimbursement was significantly reduced, with no clear resolution

Optimizing overturn rates left many denials underpaid And, prioritizing accounts receivable days and write-offs allowed payers to issue denials and not be held accountable.Working with CorroHealth, these health systems developed a strategy that included collaborating, measuring their efforts and partnering with local leaders to influence change Ultimately, one system, with more aggressive appeals, was able to increase their net inpatient payment rate from a low of 50 percent to 72 percent. That led to payment improvement of $16 million for Medicare Advantage patients

- Health systems are facing tighter-than-ever financial dynamics And payers have a great deal of power But with the right strategy and a knowledgeable partner, health systems can retrain payers and improve their fortunes, especially to denials.