Six Essential Steps to Building a Payer Matrix
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Process Wheel
26 October 2018 - 14:12, by , in Blog, Post Acute, Comments off

A well thought out payer matrix can become the central knowledge base of any revenue cycle department. It’s a resource that will serve many operational purposes and ensure that organizational knowledge is well distributed without being lost. Since home health and hospice providers may have vast amounts of payers or locations, a payer matrix will be a vital tool for centrally storing information on obtaining insurance verifications, authorizations, billing guidelines, follow-up techniques, and reimbursement rates. Additionally, the contracting team can use the data to better understand the contract, monitor events, and pass knowledge from employee to employee. A comprehensive matrix will not only be an information database but also an important training and onboarding tool.  When built properly, both new and current employees will have all the information they need right at their fingertips.

Below are six essential steps to properly build your payer matrix:

Compile all Payer Contracts

The first step in any matrix development is to gather the source data. In this first step, gather all paper and electronic contracts. Be sure to gather only the most current version of the contract.

Identify Key Pieces of Information for Matrix Headers

In most cases, the billing, authorization, and eligibility departments will be your main audience. The contracting and finance team may also be using the matrix from time to time. When developing the matrix headers, be sure to keep all these stakeholders in mind. Consider what information they would need to see daily to perform their job duties effectively. From here, establish appropriate headers. Decide on an acceptable number of headers, not too few or too many. A matrix with not enough information is just as useless as one with too much information. Payer matrices need to be user-friendly, but also contain enough information that employees will find it beneficial in their work. Remember, field headers can be added later.

To make the matrix as intuitive as possible, group common headers together. In general, most home health and hospice matrices use these header categories:

  • General Payer Information
    • Contract start and stop dates
    • Payer contact information (phone number, website URL, claim address, and fax number)
    • Rate information by service
    • Payment methodology and billing codes
  • Billing Operations
    • Method of sending claims, posting cash, and receiving claim payment
    • Timely filing guidelines
    • Payment timelines
    • Common processing issues, tips, and tricks to better understand the payer
  • Authorization & Eligibility Operations
    • Authorization requirements
    • Method to request authorization and eligibility
    • Retro-authorization guidelines
    • Services not authorized

Think-outside of the box when developing the headers. Incorporate any new fields that will significantly improve operations. For example, fostering a better understanding of payers by utilizing a payment timeline data field. During months where cash is a little tight, you can use this to identify the payers that have the quickest payment timelines to focus staff efforts for a quick cash injection.

Identify the Software

While gathering the matrix information, you must also identify which software you will use for your matrix.  Use the software available to your advantage. It is best to go with a program that can easily organize large amounts of data. Options include, Excel, Access, or an investment in a documentation management software. Another thing to consider is the number of users who will need to access the file at one time from a central location. As you will see below, this functionality is paramount as many employees will be in the matrix at once.

Compile the Data and Enter into Matrix

Solicit information from staff in each function and bring the provided information together with the contract data. Ask for input regarding payer tips and tricks, key contacts, timelines, and any other information not found in the contract. In many cases, a formalized Payer Matrix Committee should be formed to lead this project. Organize the information and begin to enter it into the matrix. Double check and proof-read the data after it is all compiled. You will be entering large amounts of data, so it is very easy to make a mistake.

Distribute and Use the Matrix

Once the matrix is completed, distribute it to all employees who will use it. Store the matrix in a centralized location so that it is easily accessible. Since many people will be going in and out of the matrix, you must consider password protecting the data from being edited by unauthorized users. In doing so, you will limit any issues with deleted or inaccurate data. Only a select group of people (your committee) should be able to make any changes going forward.

Develop short trainings or literature on how to view and use the matrix in accordance with your organizational goals. This is very important to obtain buy-in from staff who should use this in their day-to-day work. It is also important to make this part of your new hire orientation or training as noted earlier. Be sure to point out key components of the matrix and how they can be beneficial to employees. Lastly, let everyone know what the process is when something on the matrix needs updating. More on this in the section below.

Maintenance and Updates

A well-run matrix remains accurate as new information is identified and contracts are updated. Don’t let all the effort to building the matrix be wasted because it is not kept up-to-date. Updates will come from a variety of sources. Employees may discover new tips they want to incorporate, a contract may be updated, or a manager wants to start tracking another characteristic. Each of these are valid reasons to update the matrix. Therefore, a process for defining how to update the matrix should be created. A formal process will help with organizing the incoming information to ensure nothing is missed.

We all know that data is king, and a well-developed matrix can set your organization on a path to improving operations in a big way. We encourage you and your organization to take these steps to ensure your revenue cycle is primed for success.  As a strategic partner to home health and hospice agencies across the country, McBee will partner with you in setting up your payer matrix and helping you identify a process that will result in the successful sharing of organizational knowledge across stakeholders.

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