Solutions

Getting Maximum Revenue from Your Managed Care Contracts

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.

Why You Should Review and Negotiate Your Contracts

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.

Protect Your Revenue from Degradation

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.