3. Better protection against denials
Edwards notes that denials protection is growing in importance among hospitals, which are concerned about actual reimbursement yields in relation to denials. A hospital could negotiate a 6% rate, but in the face of clinical and administrative denials the yield might be only be 3% or 4%.
"Hospitals are saying that they know they can't get 9% anymore, but if they negotiate 6% then that's what they need to get. Hospitals recognize that trend isn't going to be their friend anymore so they have to do better on yield. They are looking for ways to protect themselves."
4. Better claims processing and payments
Payers are the bank, says Edwards. They hold the money and control the process. Claims processing, protection against denials, and better contract language are variations on the same themes of timeliness and accuracy.
"It's not whether a hospital will get paid, it's how long it has to wait for the correct payment," Edwards says.
Hospital claims are usually expensive and complicated because they have a lot of moving parts. Insurers complain that hospital claims are often incomplete and filled with errors. Hospitals contend the claims rules are often unclear and open to interpretation.