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Determining which plans are critical to your bottom line is crucial. Then you have to know what to negotiate for - not just fees but contract language as well. We know what services matter. We know who to talk to. We know how to leverage the value of our physician-business partnership, and how to get the right things done. The right actions can add 5-10% to your top line, which adds more than 10-20% to your bottom line. You can expect:
- Negotiated annual increases for all major health plans to insure rates are competitive and above market standards.
- Routine audits of fee schedules, making sure the managed care plans are honoring the terms and quickly correcting any errors.
- Expertise with translating quality into dollars with pay-for-performance models aimed at maximizing reimbursement.
- Expertise in best practices for contract language and terms of your managed care contracts.
 How we work with health plans
How we measure success
How we work with health plans
Our experienced Managed Care Contracting Team works with health plans to:
- Effectively negotiate on your behalf on both fee and contract language.
- Intervene on practice-related issues.
- Fight for expedited credentialing and secure payment for services rendered while in credentialing.
- Work to have restrictions lifted for your specialty. Like having health plans pay for services such as gyn ultrasounds, mammograms, or bone densitometry, restricted to other specialties.
- Serve as your advocate on contract issues, administrative challenges, changes to health plan policies and procedures.
- Have clinical experts and Medical Directors advocate on your behalf.
- Implement campaigns to get new services covered.
How we measure success
- An emphasis on strategy for negotiations. For instance, we were successful in persuading major health plans to shoulder some of the costs of professional liability premium increases through the implementation of a liability surcharge initiative.
- Strong relationships with payers.
- Market assessments of plan fee schedules.
- The ability to analyze contracts negotiated by other entities such as IPAs and PHOs.
- Streamlined administration (for example, we notify the plans of changes to office locations, provider retirements, updated accreditation, and the like).
- Collaboration between our Teams responsible for billing, clinical and managed care allow us to analyze billing data and clinical information to identify trends and pinpoint opportunities for improvement.
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