Resource Centers:(News, information, and tools to support your practice)
March 2010
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Organizing your managed care contracts
Do you spend valuable time searching for your signed managed care contracts every time you need them?
You know you need to safeguard these contracts for reference and liability and keep them in a safe and convenient place, but what can you do to make accessing these contracts smoother? Organize!
Why waste priceless practice time when you could have these important documents organized and at your fingertips. Having your managed care contracts organized will assist you in making better decisions when it comes to choosing which managed care plans are right for your practice.
Plan of action
Each original managed care agreement should be in a separate file folder labeled with the managed care company name with its own cover page. Creating a cover page summarizing the contract specifications will help you and your staff locate and reference the document without having to reread the entire agreement.
Each file folder should then be in one hanging folder labeled “original managed care agreements” with an additional copy of the cover page kept in a three-ring binder labeled “managed care plans” at the insurance or front-desk area.
The process should be something to the effect of:
1. Make a list of all the managed care plans you participate in.
2. Locate the original contract for each of these plans. (This may take some time if you are not already organized, but must be done.)
3. Take one agreement at a time and review it — using a highlighter to note specific items in the contract your office must be aware of. For example: Specific codes required by the plan, pay structure, late submissions, late payments, and CPT allowable codes. Highlight the specific area on the page, write the topic and page number on a sheet of paper to be noted on the cover page.
4. If specific forms are required by the plan for reimbursement or authorization, find out where to obtain these forms and keep a clean copy of the form with the original agreement as well as in the three-ring binder. Keep original forms in a plastic sheet protector to avoid becoming worn.
5. Complete the cover page and make a copy for the binder.
6. Once one managed care plan is completed, begin the next until all your current plans are organized. Continue to use this procedure for any plans you sign on for in the future.
Handling updates
Contact your managed care carrier and find out how they notify your practice of updates and changes, such as mail or e-mail. Assign a staff member to receive these updates, but make a note for your records in case there is a staff turnover so you can reassign this task and still receive your updates without interruption.
When updates to a plan are sent from a managed care company, the person you assigned to receive these updates must read all the managed care information and updates, highlight the changes that specifically effect procedures or fees, and have him or her inform you — as well as note the changes on both cover pages.
Both cover pages need to be updated with the new information and a copy of the update needs to be placed in the folder with the original contract as well as in the three-ring binder. Note and date all changes and updates.
Ease of use
Once you have the managed care cover pages
New staff members will also be able to obtain information they need at a glance instead of searching for it, or worse, causing financial errors that result in the loss of a patient.
It will also be easier to determine the actual cost of belonging to a particular plan. Some plans require so much of paperwork, faxing, and staff time that you may decide it is not worth the price to participate in that particular plan. Query your patients in your database and see how many you have on a particular plan and review the managed care cover page for quick calculations.
Once you have this project completed and this procedure in place for future managed care plans you choose to participate in, it will save you and your staff time, money, and confusion — and assist you in making smart business decisions.
Patty LaSorsa is the director of membership services at Breakthrough Coaching. She can be reached at 800-723-8423, info@mybreakthrough.com, or through www.mybreakthrough.com.
** A cover sheet helps keep your managed care contracts organized and at your fingertips. To see a sample cover letter, visit www.ChiroEco.com/managedcare.
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What should be on a cover sheet?
The items on the cover page should be typed, but the notes may be handwritten to avoid delay in creating the document.
Below are items you should look for in the contract and note on the cover page. If there are other items pertinent to your office procedures, you should add them to your cover page as well.
Items you should look for in the contract and note on the cover page include:
• List of CPT codes the plan accepts (How often is this updated and where do you get the updates?)
• List of CPT codes they do not accept (How often is this updated and where do you get the updates?)
• Fee scale (How often is this updated and where do you get the updates?)
• Do patients need authorization? (If yes, what is the procedure?)
• Do patients need a referral? (If yes, what is the procedure?)
• Does the plan require its own forms? (If yes, where do you get the forms? Keep a clean copy of these forms with this cover page and the original contract.)
• Is there a maximum number of office visits on this plan? (If yes, what is it?)
• Can authorizations be submitted online? (If yes, obtain Web site, e-mail address, passcodes, etc.)
• Find out the submission deadlines for authorization and billing
• Are they associated with other plans? (If yes, get the names of the plans.)
The cover page should also include the following:
• Managed care company name
• Mailing address for claims
• Contact phone number
•Fax number
• E-mail address
• Identification number
• Managed care Web site address and passcode
• Additional comments (leave room for notes)
Updates: (Regular updates to the contract should be noted on the cover page, dated, and a copy of the update placed in both the original folder and the three-ring binder.)
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