Managed Care Contract Services
Assure compliance protection and decrease payer request burden.
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In the real world, how much time and attention do we give to the medical records section of managed care contracts?
If your organization is like most, it is a low priority, and there are three reasons why:
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Many payer contracts include a medical records section that outlines the payer process for requesting medical records and the related financial terms. When negotiating these agreements, the payer contracting department may not understand the compliance and financial risks across the organization, or the burden that is placed on the HIM team by the terms for managing payer medical record requests.
- The healthcare provider may not be equipped with the right data and intelligence to bolster negotiations with payers regarding medical record requests.
- The sheer volume and complexity of managed care contracts, makes it difficult to scrutinize every agreement.
The MRO team can provide the right data and intelligence to bolster negotiations with payers regarding medical record requests.
Learn more strategies for negotiating medical record language in managed care contracts from our previous webinar.
Using Data and Expertise to Help You Negotiate
MRO’s Managed Care Contract Services team works with healthcare providers to lessen the burden of medical record requests by providing recommendations to negotiate the terms of payer agreements.
Interpret Payer Language
MRO helps you decipher the managed care contract terms, including payers’ rights to obtain records for the purpose of paying claims, aggregating data and analyzing records for risk adjustment and more.
Analyze ROI Data
Our team reviews and analyzes your data, which is securely housed in our ROI technology solution. With this analysis in hand—including who submits requests, volume of requests, average page count and average invoice price—you are better equipped to negotiate terms of agreements with payers.
Recommend Contract Language
Our team provides educational services to help you review and update managed care contracts with fair and compliant language specific to obtaining medical records for all types of payer contracts.
Our goal is to support you, to make sure your HIM team is protected against undue burden.
There are no extra fees, no additional charges. We do this as part of our service to you.
The Rising Tide of Payer Requests for Medical Records: How to Shore Up Your Defense
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