Hospitals and doctors’ offices that receive payment from insurance companies or government benefit programs need to conduct annual payment reviews. Annual payment reviews are a way for these insurance and government programs to make sure that all hospitals and doctors’ offices that take part in the program follow the strict guidelines set forth by the contracts that were signed.
There are companies that can be hired to handle payment reviews or conduct a managed care review. These companies will send in a series of workers who are trained in assessing a payment system for contract compliance and payment compliance. They will review the system that is in place, look over records, and assess the entire situation.
When the company that is conducting the payment reviews finishes its assessment, it will present its finding to the hospitals, doctors’ offices, and the insurance or government agency. These findings can come back with a good report or with a list of suggestions on how to change the program to make sure it meets contract obligations. Suggestions provided by the company can range from ways to improve revenue recovery to bill collecting.