We follow a disciplined process in our approach using these pillars throughout our engagments to develop the best proposal to achieve our clients goals.
We use custom tools we specifically built to assess your actual claims, executed contracts, and remittances from each payer.
Next, our team uses this assessment to identify the specific areas that cause these results. Once the tools are developed, we can see how and where to negotiate language, methodology, or rate changes to achieve your goals.
Our negotiators have senior level experience in both payer and provider systems.
They use our superior analytical tools with their experience and relationships to give our clients unique insights into the payers thinking which allows us to develop successful proposals to meet your goals.
Have your negotiations resulted in contracts that are operationally efficient and financially effective?
All the information is shared with your team to help them understand and comply with the requirements of the contract. This helps ensure your system gets paid the hospital revenue you expected.
It’s no secret that managed care contracts for commercial, Medicare Advantage, and Medicaid insurance products are intentionally complex documents. Payers often include multiple attachments, amendments, and updated fee schedules one must wade through.
To get the maximum revenue from these agreements, hospitals need to have a thorough understanding of their goals for each agreement and the requirements within each clause. Creative Managed Care Solutions is here to give your organization the insight you need.
You shouldn’t assume that payer policies are the same as CMS. Even when the contract says they follow CMS, we find frequently that payers’ actual polices are quite different. The payers created these managed care contracts with hospitals to serve their own needs as profit-maximizing businesses. This is a very different focus from most healthcare providers.
These payer agreements are legal documents that specify the operational, clinical, and financial obligations that providers are required to fulfill before payers are legally required to reimburse you.
Don’t let your healthcare organization -- or your patients -- be taken advantage of. Consult with us today to ensure your contracts are as fair and efficient as possible.
Our experienced team reviews your agreements and renegotiates them as necessary on your behalf.
We often find that healthcare organizations focus on negotiating the rates only to find that their expected realized hospital revenue is not being generated by the contract payments. This is caused by the language and the structure of the agreement, which -- if not fully understood -- can negate the payment rates. Payers are adding conditions that moves their business risk to providers as the United States moves from volume to value. Without senor level executives on your team dedicated to monitoring, measuring, and negotiating these policy changes in your existing managed care contracts, your revenue can be degraded during the term of an agreement. Protect your revenue from degradation by partnering with us.
