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Why it’s important to review payer correspondence

Physicians and their staffs are encouraged to closely review all correspondence, including bulletins and newsletters, sent or published by payers. Monitoring and closely reviewing correspondence is important as it may contain vital information that significantly affects a practice as well as individual physicians within the practice.

Correspondence may include notice of changes to essential aspects of the relationship with the payer, decreases or increases in reimbursement, changes to the claim submission or appeal processes, modifications to plan participation requirements or changes in network status. Depending on the circumstances, all of these could have a significant impact on a practice. A few recent examples of important information in correspondence from payers are noted below.

  • Notification of a reduction in reimbursement rates and the effective date of the reduction.
  • Information on the physician rating system and the process for challenging ratings.
  • Announcement that board certification is now required for network participation and that a physician has “X” number of years to obtain such certification or his/her contract with the payer will be terminated.
  • Changes to pre-certification requirements.
  • Notice that a physician will be terminated or “deselected” from the network.
  • Modifications to a payer’s medical clinical policies.

Practices should keep in mind that not all correspondence comes via regular mail. Some payers may announce important information via newsletters, bulletins or general messages posted on their website. Therefore, practices should consider signing up to receive electronic updates or newsletters published by payers and monitoring payer websites for important announcements. Any questions about correspondence should be directed to the payer.

For efficiency purposes, practices often designate one staff member to monitor and track all correspondence from payers. This decreases the chance that correspondence will be misdirected, overlooked or accidently discarded and ensures the practice will be able to evaluate how the information may affect the practice in a timely manner. Copies of payer correspondence should be filed with any contracts the practice has with the payer.

Back to May 2, 2013 Medigram