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Five Years on, Biosimilars Need Support from All Health Care Players 


If you think your practice has taken the steps to optimize your revenue by adjusting your Accounts Receivable strategy, now may be the time to look at the fine print of your payer contracts. This can be a complicated process and may take time, but understanding your challenges with your payers, especially your top payers, can be an effective tool in optimizing your revenue cycle management.

“Providers can expect to feel the impact of COVID-19 long after the public health crisis abates. Given that payers control a significant portion of providers’ revenue, the financial pressure on providers and successful navigation of the post-pandemic environment will require providers to reset their relationship with payers.”1

While you will probably understand the reimbursements for commonly billed services, updates may have been made during the public health emergency. Some things to consider in your contracts include:

  • How will cost sharing waivers be administered so providers avoid losses?
  • What claim requirements have changed?  These include codes, modifiers and NDCs.
  • What requires authorization?  Have any requirements relaxed?
  • How long will the changes be in place, and is there an opportunity to permanently extend coverage policies?

Working and communicating with your payers during this time is essential. Payers understand that there are lower patient volumes, many patients are being seen through telehealth appointments and revenues for practices may be decreased. If your practice can quantify the administrative burdens to seek relaxed guidelines, even temporarily, payers may be willing to work with you. This could ensure your practice better financial strength and flexibility.

Our Business Optimization team can help you understand the fine print and work with your data to share in communications with your payers. To learn about how they can help your practice, email