It is not just about fee-for-service anymore.  Managed care contracts can have many components and some can be very helpful to your practice, when it is done strategically.

Contracts are not “one and done” any longer.  They should be worked and examined and maneuvered constantly.  Strategy needs to be developed and deployed to maximize return, maximize volume and make the practice most efficient.

Increasingly it is NOT as much about what you’re paid as it is the global cost of a member’s care.  Health plans would love their provider network to lower the cost of care.  We believe you should be paid to do it by getting a portion of the savings.  We believe the choices providers make (site of service, frequency, ancillary services, etc.) affect the cost of care and your ultimate reimbursement opportunities.

  • What contracts do you hold and what is your reimbursement rate with each?
  • What patient volume are you receiving in return for any discount of billed charges?
  • Do you know what is a good contract relative to the services you provide?
  • Are you being paid correctly?
  • Are you maximizing your potential?

Our experience tells us that most practices do not have appropriate information about their contracts and reimbursement. With the ever-changing managed care world, with new lines of business and new amendments frequently hitting your desk, it is crucial to have knowledge and information at all times.

Like the game of chess, in order to be successful you need to plan ahead and make strategic decisions. We provide complete independent research and strategic assistance with managed care contracting issues.

  • Discovery of what health plans you are contracted with and their Value to you, how you are contracted and your reimbursement rates.
  • Negotiations Assistance – Who to talk to, how to engage them, how to “sell” your practice to obtain fair reimbursement and terms. We will help you create a strategy and leverage that works!
  • Discovery of and attention to narrowing networks.
  • How to approach self-funded and direct funded plans.  Have you ever had a direct relationship with an employer for direct funding?
  • Contract Valuation – Comparing apples to apples, we will show you the your contracts based on the services you provide.
  • Creation of expected payment reports – by payer, by CPT code. With the correct code, you will know if you are being paid correctly!
  • Examination of fee schedules – are you leaving money on the table?
  • Initial acquisition (including credentialing) of managed care contracts
  • Reassignment of managed care contracts (change of corporation and Tax ID, address, addition of providers to Tax ID, etc.)

Managed Care Contracting is a Game you Need to Win!

Managed Care contracting is a game, and one you need to win!  It is now more than just what rate and what year of RBRVS or Medicare.  It is an on-going strategic relationship with all your payers, holding them to task, requiring service and responsiveness!

It helps if you have a team, its helps if you have someone on your side. Play to win!