Why is Payer Management Important in Healthcare?

Receiving whole-body care from one facility or practitioner is challenging because the healthcare sector has numerous facets and sections. This is when the need for coordinated care throughout the healthcare continuum arises. So who is in charge of the coordinating process and why is payer management important? 

We’ll dive into why payer management is important and what is healthcare doing to coordinate and streamline care across all healthcare providers.

 

Payer management is crucial when we discuss medical billing. Payers are typically categorized in four ways: health plans, payers, insurers, and payviders. A common misconception is that these are all synonymous with each other, but they’re not exactly interchangeable terms.

There is always a chance that anything could go unnoticed when a patient moves from one healthcare facility to another, such as going to the hospital and then returning to their primary care physician. Primary care physicians (PCPs) frequently come across care gaps that are beyond their control during transitions of care as a result of things like unavailable patient records, hazy discharge care plans, or minimal effort on the part of others to involve the primary care team or the patient and their caregivers.

Recognizing this, payers started paying nurses and doctors to oversee care in those gaps , ensuring a smooth handoff between the various care silos. ADT (admission, discharge, transfer) notifications have also been added by some payers so that physicians can communicate with patients during transitions.

 

Health plans pay the cost of medical care, while the payer processes and pays provider claims. The most common type of payers are insurers (insurance companies). Meanwhile, payviders are healthcare service providers who are also payers.

 

With AZ Billing’s Payer Management service, we implement a custom medical billing process that identifies underpayments and tracks denial reasons to help increase your net revenue and margin. We also offer services to assist in electronic billing and SFTP setup.

 

With these, we simplify billing formats, customize payment models, and untangle the medical billing process, making it easy for payers to pay for your patient care, which you can improve by improving your fiscal outcomes with us.

Payer Management has never been easier with AZ Billing.

 

Schedule a consultation with us now to learn more.