Have you analyzed your managed care contracts to make sure the terms benefit your facilities needs as much as possible? We can help you review and renegotiate your contracts with managed care organizations (MCOs), which can result in increased net revenues.
Managed Care Contracting Review and Negotiation:
Your challenges:
- Determining a fair reimbursement proposal
- Collecting copies of your current managed care contracts
- Understanding how the language in your agreements affects your practice
- Managing contractual provisions (e.g., expiration, termination)
- Gathering data on visits using Current Procedural Terminology (CPT) codes by payor
- Gathering data on HEDIS measures
- Differentiating your facility from the competition
Our managed care contract consulting services:
- Analyze your fee schedules against the most current reimbursement rates and market data available for your specific area
- Review your Explanation of Benefits (EOBs) to verify what you have been paid
- Assess reimbursement rates and develop a plan for an increase
- Review and edit the contract terms
- Negotiate with Managed Care Organizations for increased reimbursement carve outs
- Educate management and staff
Our approach:
Southwest Medical’s health care team will provide an in-depth review of your reimbursement rates against contractual agreements. We will also determine which reimbursement rates should be renegotiated based on your market (geographic region).
We work with clients to identify problems, and we pay close attention to opportunities for improvement, including the revenue cycle. We’ll provide a tool to help your facility continually manage payer contracts. You’ll also benefit from our assistance in developing a long-term strategy to maintain optimal managed care contracts.
Our health care professionals have extensive experience assisting independent, integrated, and hospital-owned physician practices and ambulatory surgery centers (ASCs) with managed care contracts, reimbursement negotiations, revenue cycle management, electronic health records (EHRs), and operations performance improvement.
