The Essential Guide to Healthcare Payer Contracting

Tanja Twist, MBA/HCM

Payer contracting is integral to ensuring facilities are paid appropriately for the services they provide. Unfortunately, both the contracting process and the payer contracts themselves can be difficult to navigate.

Fortunately, The Essential Guide to Healthcare Payer Contracting takes all the guesswork out of the topic. This comprehensive book covers a range of payer contracting essentials to ensure it meets the needs of both seasoned professionals and those working on their first contract.

Author Tanja Twist, MBA/HCM, takes readers through the whole process from start to finish, from the basics, such as reviewing contracts (who should review, how to review, and when to do it) to more advanced topics, such as meeting time requirements, negotiating and renegotiating contracts, and maintaining a healthy relationship between payer and facility.

Benefits

• Accessible for all levels of knowledge – This book will help all professionals develop their knowledge base on payer contracting, hone their terminology, and feel more confident when working with payers, whether it’s their first contract or their 15th.
• Increase reimbursement – As healthcare costs continue to rise and payer reimbursements decrease, improving hospital revenue through effectively negotiated contracts can be an effective way to boost reimbursement .
• Up-to-the-minute guidance – This book offers up-to-date information on payer contracts from an author who is currently working in the healthcare field and has more than 25 years of revenue cycle experience.

Published: October 2018

Page count: 150
Dimensions: 8.5x11
ISBN: 978-1-68308-810-3

Table of Contents

Chapter 1: History of Contracting
Chapter 2: Overview of Contracting Today
Chapter 3: Payer Networks
Chapter 4: Future of Contracting
Chapter 5: Reimbursement Methods
Chapter 6: Preparing for Negotiations
Chapter 7: Reviewing the Contract Document
Chapter 8: Language and Terms
Chapter 9: Denials
Chapter 10: Negotiations
Chapter 11: Contract Management

About the Author

Tanja Twist, MBA/HCM, has more than 25 years of experience in healthcare revenue cycle management, with a focus on reimbursement and denials management. Twist has held the position of director of patient financial services, as well as overall operations officer for large and small hospital facilities, professional providers, and provider groups. Twist currently works for Cedars-Sinai Health Systems. She advocates for hospitals and providers nationwide, providing revenue cycle management services supported by a deep knowledge of state-specific issues and unparalleled expertise in Medicare, Medicaid, and commercial reimbursement.