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Orion HealthCorp Commentary Featured in HFMA's Revenue Cycle Strategist.

Key Executives Outline the Necessity of an Expert Managed Care Compliance Team in Analyzing Contract Variance

ATLANTA, Feb. 21, 2011 /PRNewswire/ --Change is a constant in healthcare as individuals seek out new insurance plans and insurers offer new products and services. With help from qualified medical billing experts that put a strong emphasis on skilled managed care compliance teams, healthcare providers are monitoring variances in managed care agreements ensuring they receive appropriate reimbursement, according to a recent article in the February issue of the Healthcare Financial Management Association's (HFMA) Revenue Cycle Strategist. The article, entitled, "Contract Variance Management: Not by Software Alone," was penned by Orion HealthCorp executives Cindy Luu and Sarah Gattis.

"Overseeing constant changes in healthcare requires smart software to handle the complexities of managed care billing, but software alone cannot prevent errors due to contract variances," said Cindy Luu, Chief of Information Services for Orion. "The expertise of a managed care compliance team that routinely and continuously analyzes contract variance results is essential to determine the cause of payment variances."

According to Luu, the compliance team must carefully monitor managed care contracts, and update the contract variance module accordingly. "Many medical billing software companies and medical billing services proudly state that they have a contract variance module in their billing application to detect payment errors. But beware: Managed care payment compliance with its many contract variances cannot be maintained by software alone."

A knowledgeable and expert team can help

Most certainly, software is a tool that provides valuable support for handling large volumes of insurance plans and fee schedules, but unfortunately it does not automatically update itself. That requires human knowledge and expertise.

"Errors can result in underpayments to providers and lost revenues that--especially in today's economy--should certainly be avoided," said Luu. "The errors may result in overpayments, as well, and those overpayments can mean serious liability for a hospital or physician practice if not dealt with quickly."

For example, earlier this year, Medicare and Aetna implemented multiple procedure reduction policies that resulted in a payment reduction for second and subsequent CT scans, MRIs or ultrasounds performed on the same date of service. A compliance department should identify and confirm such variances and work with IT to enhance the medical billing company's software so that it recognizes these acceptable payment reductions.

A dynamic process requires constant vigilance

Indeed, reimbursement monitoring is a dynamic process, requiring the team to stay abreast of legislative mandates, payer policies and fee schedule updates throughout the year. A compliance department should frequently review payer newsletters, notifications and websites to spot new exceptions and validate them.

Having a dedicated and enthusiastic compliance team --one that diligently researches updates, continuously monitors reimbursements, and establishes good relationships with insurers--brings enormous value to medical practices, ensuring proper reimbursement no matter how often the contract landscape changes.

To read the entire article, please visit

About Orion HealthCorp, Inc.

Orion HealthCorp, Inc. is a valued partner to physician groups, laboratories, imaging centers and other healthcare providers who require the specialized medical billing and practice management processes and technology necessary to successfully maximize the recovery of earned revenue and to manage stringent industry compliance mandates. The company supports thousands of office- based physicians and hospital specialists in pathology, radiology, and anesthesiology; and delivers an intense focus on personal relationships and company accountability. Innovative tools, technologies, and operational processes enable the Orion team to capture revenue that other companies overlook and help clients mitigate the risks associated with medical billing, collections, and practice management. Headquartered in Atlanta, Ga., with offices in Alabama, California, Colorado, Illinois, Ohio and Texas, Orion HealthCorp is among the top medical billing and practice management companies in the United States. For more information, please visit:

SOURCE Orion HealthCorp, Inc.
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Publication:PR Newswire
Date:Feb 21, 2012
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