Providers across the country continue to deal with various payer issues that create an enormous amount of administrative rework.
Any way you slice it, the process of billing a claim and getting it paid just isn’t always that easy. I feel their pain and want to try and be part of the solution to a more efficient and effective system.
Georgia HFMA supports providers in their efforts to be more productive and reduce this amount of rework.
In an effort to foster collaboration between payers and providers, I hosted another Spring Payer Forum on behalf of the chapter. This year’s event was again virtual with one payer scheduled for an hour each day, and two presenting on Friday.
The idea is for payers to provide any updates that providers need to know about and for providers to ask any questions or bring up issues that they are experiencing in getting paid for services provided.
Payers on hand included Medicaid (Gainwell Technologies), Medicare (Palmetto GBA), United Healthcare, Anthem, Ambetter (Centene), and Humana.
Each of the payers was very willing to support our event. We have had most of them participate in the past and were successful in getting a few others to join in this year. We had about 375 attendees in all who logged into the Zoom calls and listened along and then asked a number of questions.
More and more, each payer is encouraging providers to access their website and portals to check claim status, and to get the latest updates, contacts or guidelines.
I had been hearing some rumblings of issues going on with various payers as well as some of the contract negotiations around the state between providers and payers. Much of the challenges seem to be centered on consistency around what information is provided when calls are made through the various call centers.
Not all of the representatives seem to be as familiar as others when hospital representatives call in. This has been an ongoing issue—the pandemic has had an impact on staffing for the payers, too.
Ultimately, it comes down to trust.
Healthcare providers always feel like they are entitled to more reimbursement than the payers think they deserve. Even once those reimbursement levels are set, it takes a lot more work to get a claim paid than it should.
We need to work together, collaborate, and escalate the issues that are causing delay in payment.
HFMA is one of the resources out there committed to being part of the solution.
Don’t let up! Don’t play the victim! Stick up for what you believe is right and hopefully in the end, we’ll all prevail.
Bill Eikost, FHFMA has spent the last 30 years helping hospitals identify ways to improve cash flow and accelerate collections from all available sources. He is a Fellow in the Healthcare Financial Management Association (HFMA) and a recent Past President of the Georgia Chapter of HFMA. During his time at Nemadji, he has been an invaluable asset responsible for forging and maintaining long-term client relationships and national accounts, as well as strengthening strategic partnerships.
