Contracting, Credentialing and Negotiating with Managed Care in Audiology

As healthcare costs continue to rise, many healthcare providers, including audiologists, are turning to managed care organizations as a way to control costs and improve patient access to care. However, contracting, credentialing, and negotiating with managed care can be a complex and time-consuming process.

Here we will explore the process of contracting, credentialing, and negotiating with managed care in audiology and how you can manage it with outsourcing it to a platform like Sybrid MD.

Contracting with Managed Care Organizations:

The first step in working with managed care organizations is to establish a contract with them. This process involves negotiating the terms of the agreement, including payment rates, services covered, and patient eligibility requirements.

1. Research and Evaluation: Before entering into a contract, audiologists should research and evaluate different managed care organizations to determine which ones are a good fit for their practice. Factors to consider include payment rates, patient demographics, and the organization’s reputation.
2. Contract Negotiation: Once a suitable managed care organization has been identified, audiologists must negotiate the terms of the contract. This involves discussing payment rates, services covered, patient eligibility requirements, and other terms of the agreement.
3. Contract Review: Before signing a contract, audiologists should review it carefully to ensure that all terms are clear and acceptable. It’s also a good idea to have a lawyer review the contract to ensure that it complies with all applicable laws and regulations.

Credentialing with Managed Care Organizations:

1. Credentialing is the process of verifying a healthcare provider’s qualifications and professional history, including their education, training, licensure, certification, and work experience. Managed care organizations require audiologists to go through the credentialing process to ensure that they meet the necessary qualifications and standards.
2. Application Submission: Audiologists must submit an application to the managed care organization, providing information about their education, training, licensure, and work experience.
3. Credentialing Review: The managed care organization reviews the application and verifies the information provided, including checking for any disciplinary actions, malpractice claims, or other issues that could affect the provider’s ability to deliver safe and effective care.
4. Approval or Denial: Once the credentialing review is complete, the managed care organization will either approve or deny the application. If the application is approved, the provider will be added to the managed care organization’s network of providers.

Negotiating with Managed Care Organizations:

Negotiating with managed care organizations is a crucial part of working with them. Providers must ensure that they are being fairly compensated for their services and that the terms of the agreement are reasonable.

1. Negotiating Payment Rates: Payment rates are a significant factor in negotiating with managed care organizations. Providers should research and evaluate payment rates offered by other organizations to determine fair compensation for their services.
2. Negotiating Services Covered: Managed care organizations may have specific services that they cover or exclude. Providers should negotiate the services covered to ensure that they are providing the best possible care to their patients.
3. Negotiating Patient Eligibility: Managed care organizations may have specific eligibility requirements for patients. Providers should negotiate patient eligibility to ensure that they are providing care to the patients who need it most.

How Outsourcing Can Help?

As the healthcare industry continues to evolve, more audiology practices are turning to outsourcing to manage the complex and time-consuming process of contracting, credentialing, and negotiating with managed care organizations.

Outsourcing these tasks can free up valuable time and resources for audiologists, allowing them to focus on providing the best possible care to their patients.

Contracting with Managed Care Organizations through Outsourcing:

Outsourcing contracting with managed care organizations can help audiologists navigate the negotiation process more efficiently. By working with a third-party vendor, audiologists can access expertise and resources that may not be available in-house.

An experienced vendor can help identify suitable managed care organizations, negotiate the terms of the agreement, and ensure compliance with applicable laws and regulations.

Credentialing with Managed Care Organizations through Outsourcing:

Credentialing is a crucial step in working with managed care organizations, and outsourcing this process can provide several benefits. An outsourcing vendor can help ensure that the application is complete and accurate, reducing the likelihood of errors or omissions that could delay the credentialing process.

They can also provide ongoing support, ensuring that audiologists remain compliant with the organization’s credentialing requirements.

Negotiating with Managed Care Organizations through Outsourcing:

Negotiating with managed care organizations requires expertise and negotiation skills that audiologists may not have in-house. By outsourcing this process, audiologists can work with experienced negotiators who understand the intricacies of managed care organizations and can help secure favorable terms. An outsourcing vendor can help audiologists research payment rates, services covered, and patient eligibility requirements, as well as negotiate these terms on their behalf.

Benefits of Outsourcing Contracting, Credentialing, and Negotiating:

Outsourcing contracting, credentialing, and negotiating with managed care organizations can provide several benefits for audiology practices, including:

1. Time and Resource Savings: Outsourcing these tasks can free up time and resources for audiologists, allowing them to focus on providing quality care to their patients.
2. Expertise and Experience: Outsourcing vendors have expertise and experience in navigating the complex world of managed care organizations, ensuring that audiologists can secure favorable terms and remain compliant with applicable laws and regulations.
3. Cost Savings: Outsourcing can help reduce costs associated with managing the contracting, credentialing, and negotiating processes in-house.
4. Improved Patient Access: By working with managed care organizations, audiologists can expand their patient base and provide more access to care.

Conclusion

Contracting, credentialing, and negotiating with managed care organizations can be a complex and time-consuming process. However, working with managed care organizations can provide audiologists with access to a broader patient population and help control costs.

By following best practices in contracting, credentialing, and negotiating, audiologists can build strong relationships with managed care organizations and provide the best possible care to their patients.