4 Bad Payer Behaviors Impacting Reimbursement for Physician Groups

Breaking Down Barriers to Payment

Combating the increasingly complicated reimbursement landscape

Payers in healthcare​ continue to create new roadblocks for facility-based physician groups to receive fair reimbursement. From complicating enrollment processes to excessive claim denials and contract non-compliance, each strategy delays payments and increases administrative burdens, all at the expense of patient care.

Read more in our piece on Becker’s Hospital Review | Download the Infographic for a deeper understanding | Experience Ventra Health’s data & analytics platform, vSight™

Excessive Denials
Excessive Denials

Unnecessary documentation requests, prepayment audits, and irregular billing and coding policies cause friction between clinical staff and insurance reimbursement​.

Contract Non-Compliance
Contract
Non-Compliance

Even when favorable contracts are negotiated, payers often fail to honor agreed-upon reimbursement rates.

Abusing Patient Protections
Abusing Patient Protections

Laws meant to protect patients can be misused by payers to deny or reduce provider payments.

Learn More on Becker’s Hospital Review
Learn More on Becker’s Healthcare

“4 Bad Payer Behaviors Impacting Reimbursement for Facility-Based Physician Groups”

Complicating the Provider Enrollment Process
Complicating the Provider Enrollment Process

Constantly shifting rules and intentionally unclear requirements create unnecessary delays.

Excessive Denials
Excessive Denials

Unnecessary documentation requests, prepayment audits, and irregular billing and coding policies cause friction between clinical staff and insurance reimbursement​.

Contract Non-Compliance
Contract
Non-Compliance

Even when favorable contracts are negotiated, payers often fail to honor agreed-upon reimbursement rates.

Abusing Patient Protections
Abusing Patient Protections

Laws meant to protect patients can be misused by payers to deny or reduce provider payments.

Learn More on Becker’s Hospital Review
Learn More on Becker’s Healthcare

“4 Bad Payer Behaviors Impacting Reimbursement for Facility-Based Physician Groups”

Complicating the Provider Enrollment Process
Complicating the Provider Enrollment Process

Constantly shifting rules and intentionally unclear requirements create unnecessary delays.

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“Fair reimbursement is appropriate and essential to ensure physician groups remain available to serve the patients seeking care at their facilities. As clinicians and healthcare revenue cycle experts, we are deeply involved in advocacy efforts and have made it our mission to improve reimbursement for facility-based physician groups.”

— Jamie Shoemaker, MD, FACEP , Emergency Medicine Strategic Advisor, Ventra Health

Read The Full Article on Becker’s Hospital Review

Payers are finding new ways to delay, reduce, or deny reimbursement for facility-based physician groups, offloading financial strain on providers and increasing administrative strain. With more time spent jumping through hoops, it’s getting harder for clinicians to focus on patient care.

Ventra Health’s leadership team outlines four increasingly prevalent behaviors from payers in healthcare​ and shares proven strategies to help physician groups evaluate their options. Learn how data-driven revenue cycle management, proactive contract monitoring, and industry advocacy can help providers protect their financial health and secure fair payment.

Read the Article

Featuring Expert Insight From:

Steven Huddleston
CEO, Ventra Health

Jason Greenberg, MD
Chief Client Officer, Ventra Health

Jamie Shoemaker, MD, FACEP
Emergency Medicine Strategic Advisor
Ventra Health

Download the 4 Bad Payer Behaviors infographic for deeper understanding

Download the Infographic

Turn Insurance Reimbursement Challenges Into Actionable Insights With vSight™

Staying ahead requires real-time visibility into claim denials, contract compliance, and enrollment status.

With vSight™, Ventra Health’s advanced data and analytics platform, physician groups gain:

24/7 monitoring to detect and prevent revenue loss.
Automated enrollment tracking to eliminate payer-related credentialing delays.
Contract compliance verification to ensure negotiated rates are honored.
Customizable reporting that makes accurate data-driven decisions possible.

  • 24/7 monitoring to detect and prevent revenue loss.
  • Automated enrollment tracking to eliminate payer-related credentialing delays.
  • Contract compliance verification to ensure negotiated rates are honored.
  • Customizable reporting that makes accurate data-driven decisions possible.
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