INSIGHTS

Risk Tolerance + Payor Contract Reviews/Audits

CATHY BOJANSKI, LUTZ HEALTHCARE MANAGER
KIRK DELPERDANG, LUTZ HEALTHCARE MANAGER

Do you walk across the street without looking both ways? Do you skydive without verifying that there is a parachute in your bag? Do you change the oil in your car regularly or do you wait for the red light to come on? Do you ever verify the automatic payment into your bank account from your employer or do you just trust that it is correct? Do you trust that the life blood of your business, third-party payor payments, are always correct as received from the payor?

There are certain things in life and in the healthcare industry that we can trust. The sun will rise in the east and set in the west and as a hospital or clinic, your primary source of income is the payment you receive from third-party payors.

However, as a hospital or clinic, you must be prudent in your operations and your financial interactions with third-party payors. Here are some items that you must consider on a regular basis as part of your “oil change”.

 

1. Do you have a copy of all of your contracts – Commercial, managed care (Mcr. & Mcd.), other

2. When was the last time you looked at your contracts?

3. Check the payor’s website to ensure you are participating

4. What else is on the payor’s website about you?

5. Are there quality/other measures that impact payment? Are you being paid for these?

6. Is the payor meeting all terms of the contract?

7. Are you reimbursed by percent of charges, fee schedule or combination?

8. When was the last time you audited the remittance advices/payments, if ever? Tie these back to the contractual terms.

9. Renegotiate?

10. Monitor payor websites (listserve) for news/updates/payment changes

ABOUT THE AUTHORS

402.827.2366

cbojanski@lutz.us

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CATHY BOJANSKI + HEALTHCARE MANAGER

Cathy Bojanski is a Healthcare Manager at Lutz with over 25 years of experience. Her primary responsibilities include preparation and review of Hospital and Clinic Chargemaster (CDM) reviews for healthcare clients, as well as assisting with coding and billing services.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Association for Rural Health Professional Coding, Member
  • Certified Billing Specialist

402.496.8800

kdelperdang@lutz.us

LINKEDIN

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KIRK DELPERDANG + HEALTHCARE MANAGER

Kirk Delperdang is a Healthcare Manager at Lutz with over 25 years of experience. He provides accounting and consulting services to healthcare and related organizations.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association - Nebraska Chapter, Member
  • Nebraska Society of Certified Public Accountants, Member
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Northern Iowa, Cedar Falls, IA
COMMUNITY SERVICE
  • St. Vincent de Paul, Knights of Columbus, Member
  • Active in various youth sports leagues: Aldrich Elementary, Millard Athletic Association, Millard North Schools, Omaha FC, Skutt Catholic High School and YMCA

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