7 payor do's and don’ts from your provider peers

When it comes to improving your revenue cycle performance, no one has all the answers. But possibly the best place for revenue cycle leaders like you to look for answers is your peers. Chances are, they’ve faced the same challenges as you and have tried different tactics to overcome them. They can tell you what worked and what didn’t work. Your peers are a real-time resource for do’s and don’ts. 

In that spirit, healthcare revenue cycle rock stars from the nation’s leading health systems gathered last month at Kodiak’s invitation-only Revenue Circle conference held Jan. 26-28 in Scottsdale, Arizona. Over the three-day event, attendees swapped stories about their successes, failures, thoughts, ideas, and tactics in trying to improve their systems’ revenue cycle performance while, at the same time, escalating claims-paying behaviors by health insurers threaten their cash flow and overall financial results. 

Attendees did their sharing candidly behind closed doors at the event. But they did agree to share some of their dos and don’ts on dealing with payors in a post-event survey. We’ve organized and slightly edited them for your continuing professional revenue cycle education. 

Question 1: 

What are the biggest reasons payors are using to underpay a claim or take back all or part of a payment made on an initial claim? 

Answers: 

• “Level of care disagreements.” 
• “Clinical validation audits.” 
• “DRG downgrades.” 
• “Delays in loading updated fee schedules.” 
• “Implementing a new payment policy.” 

Question 2:  

When you’re dealing with negative claims-paying behaviors by an insurer, what short-term tactics always work? 

Answers: 

• “Being honest and direct with them.” 
• “Going down to the last minute and sending their members letters of dropping their health plan.” 
• “Getting senior executives involved at the end.” 
• “Engaging with our provider representatives and our contracting team to work through and resolve payor issues.” 
• “I can’t say that anything always works, but arming ourselves with good data sets us up for success.”  

Question 3:  

When you’re dealing with negative claims-paying behaviors by an insurer, what short-term tactics should you avoid because they never work? 

Answers: 

• “Hurrying to respond to payor requests early. The shot clock is your friend.” 
• “Rebilling.” 
• “Using anecdotal examples without the facts.” 
• “Attitude is a big factor. Attacking them does not set you up for success.” 
• “Staff level follow-up with payors’ challenges never seems to make much of a difference.” 

Question 4: 

What are the most effective ways to hold payors accountable for their behavior in the long term? 

Answers: 

• “Being forthright with them during contract renewals.” 
• “Let them know that canceling a contract is a viable option for you..” 
• “Prepare ourself with data and benchmarks.” 
• “Ensure that you know what their contract with you actually states.” 
• “Use vendors with your payors that offer specific knowledge and experience with those payors and issues.” 

Question 5: 

What are the least effective ways to hold payors accountable for their behavior in the long term? 

Answers: 

• “Trying to automate a broken process.” 
• “Doing nothing.” 
• “Behaving in an aggressive or disrespectful manner.”” 
• “Trusting without verifying what they say.” 
• “Trusting without verifying how they say they are going to process claims.” 

Question 6: 

Turning internally now, what are your surefire tips and tricks to reduce your revenue cycle operating costs at a time when you’re being asked to do more with the same or fewer resources? 

Answers: 

• “Being skeptical of team requests to add additional staff.” 
• “Automation.” 
• “Consolidating vendor usage.” 
• “Constantly work to make workflows more efficient.” 
• “Do everything you can to avoid rework.” 

Question 7: 

What cost-reduction tips and tricks have you tried that didn’t work? 

Answers: 

• “Bots have not worked for us to reduce labor and labor costs.” 
• “Automation but probably because we were too early. Still waiting for the ROI.” 
• “Eliminating overtime.” 
• “Flexing staff resources.” 
• “Capping vendor expenditures.” 

Now that was candid (I told you so). That’s what makes their honest dos and don’ts credible, insightful, and useful to you and your revenue cycle team.  

How would you answer the same questions? Are you nodding in agreement? Are you shaking your head in disagreement? What are your successes, failures, thoughts, ideas, and tactics with the same issues? 

The revenue cycle specialists at Kodiak can help you answer those questions, as we’ve dealt with them in our work with leading health systems across the country to improve their revenue cycle performance. 

Let us know how we can help you. 

Read more insights from the Kodiak Revenue Circle: 

• “11 priorities facing healthcare revenue cycle leaders in 2025”