New Hospital Contracts: RCM Questions Emergency Physicians Should Ask

Sara RiceJuly 26, 2019

Physicians shaking hands

Emergency physician groups that are focused on growth are often looking to expand into a new hospital location or begin their own free-standing emergency department. Once the arduous legal and bureaucratic process is complete, and you have won that contract it is time to get to work.


When you do start at a new location, there are a few things that you should keep in mind, one of which is establishing the revenue cycle management process for your new location. In order for the medical billing and coding implementation process to take place without any hiccups, it’s important to focus on these four key areas:       


1. Communication

When starting a new project or job, employers usually provide an orientation and instructions on what’s expected from the employee and how to complete certain tasks. The same could be said for when an emergency medicine group begins staffing a new location. There are certain items that need to be discussed, decided and communicated to the company who will be coding and billing on the group’s behalf. Good communication between all parties involved in the starting of a new location is the best way to ensure startup success.


2. Charts

Determining how charts will be received for processing is important; without charts there’s no coding, without coding there’s no claims and without claims to bill there’s no revenue. Establishing a chart process for receiving or retrieving charts from the hospital should always be a priority, the hospital IT Department contacts should be shared with the billing company as soon as possible to begin discussions about the receiving and retrieval process.  The preferred method for receiving charts is fully electronic; this is the fastest and most efficient way to get charts transferred. If charts can’t be sent electronically there are other options for receiving charts, and the billing company and hospital IT Department will be able to determine which option is the most viable for all parties involved.


3. Enrollment

Enrollment is required for physicians to be able to submit claims to several insurance companies and the vast majority of government programs such as Medicare and Medicaid. Not submitting enrollment paperwork in a timely manner can result in the loss of an effective date, and claims with a date of service that are prior to the enrollment effective date will likely be rejected by the insurance company, resulting in lost revenue. For that reason, enrollment should be submitted as early as possible to allow time for processing and the best chance for reimbursement.


4. Contracting

Not all insurance companies back date the effective date of a contract. Thus, if reimbursement rates need to be negotiated, this could take some time. Due to the time it can take insurance companies to process and finalize a contract, it is also a good idea to communicate as early as possible if there are any insurance plans the group needs to be in network with to keep claims from processing out of network. Claims processed out of network can result in more costs being shifted to the patient. In turn, patients may file complaints with the hospital, especially if the hospital is in network and the group’s claim processed out of network.


With a new practice location, activities done during the startup process don’t always go according to plan. Knowing this, it’s important to have good communication, start key tasks early to allow time for processing as well as the management of any unexpected issues that may arise to avoid having delayed cash flow or lost revenue.

Author Bio: Sara Rice is a Senior Analyst at R1. She has been working for Intermedix for over 16 years. Sara earned her bachelor’s degree in business administration at University of Central Oklahoma.