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One of, if not the primary goal of a provider is to ensure the health of their patient. However, often the payer contracts contain confounding provisions or legal terminology that may affect patient outcome improvements. These contracts typically describe a provider’s reimbursement arrangement for delivering healthcare services to patients that have coverage based on certain health plans. The contracts are full of details, including reimbursement rates and provider networks. Making sure that these complex payer contracts are thoroughly understood is essential towards ensuring reimbursement remains correct and timely.

There are certain key terms in payer contracts that can maximize reimbursement provided they are thoroughly understood. For example, allowed amount. This refers to the maximum amount a payer will reimburse a provider for covered services. The term also goes by other names such as “eligible expense” or “payment allowance”. Clean claim is another one to be aware of, which simply means the claim is able to be processed without the need for obtaining additional information.

You can read more about these key payer contract terms at the following source link:

This update is by Abril Law, a law firm comprised of attorneys Jorge M. Abril and Sinead Baldwin. Our services include medical reimbursement,commercial litigation, and more. If you have any questions or wish to schedule an appointment, please call 305-373-0901 to speak with one of our attorneys. We look forward to working with you.

This information is provided for educational or informational purposes only and should not be construed as legal advice. The information is not provided in the course of an attorney-client relationship and is not intended to substitute for legal advice.