According to data from Reuters news organization, Americans spend more on healthcare than any other country, and has higher infant mortality rates, diabetes, and other serious illnesses than many other developed nations. For years, access to healthcare was limited for many Americans, which has prompted the creation of the Healthcare Reform Bill. Among the Healthcare Reform Bill’s many changes, it will certainly change the way healthcare and American businesses do things. There are many new components of the bill, but an important caveat is that healthcare companies will no longer be able to deny coverage on pre existing conditions, and there will be caps on deductible and out of pocket healthcare spending.
Currently, there are different types of healthcare options known as managed care. In terms of managed healthcare, it is available in different iterations. There are health maintenance organizations, otherwise known as HMOs, preferred provider organizations, also known as PPOs, and point of service plans (POS), just to name a few. Each type or tier has different associated costs dependent on the level of restrictions or guidelines on the plan which require strict contract compliance.
For healthcare providers, contract compliance of utmost importance. Contract compliance is time consuming and complicated. Not only are there managed care review procedures involved, but contract negotiation, payment compliance, and payment reviews are necessary. The cost benefit of hiring a managed care and contract compliance solution provider can mean thousands of dollars of revenue recovery that goes directly back into your practice or hospital. Additionally, having an expert on board who can ensure you are in contract compliance could potentially save you even more in fees, penalties, and fines.