Managed Care Contracting Health Care Consulting

Managed Care Contracting

Improve Top-Line Performance with Contract Confidence

The reimbursement rates negotiated with managed care companies in your local market are critical to a healthy margin. Ensuring you’re being paid fairly requires benchmarking and an understanding of best practices prior to successful contract negotiation.

Reaching an agreement with a payor about managed care services and reimbursement requires preparation, data analysis and negotiation. BKD’s team of Health Care Performance Advisory Services professionals can help you determine if your organization is well positioned with major payors in the market and develop a road map to improve payor relationships.

Benchmarking

Effective negotiations begin with a comparative assessment of your reimbursement with state and regional markets. Favorable rates are often achieved for one or two service lines, while others lag behind. By taking a deep dive into your major service lines and evaluating rates in light of strategic growth plans, BKD can help to align investments with needed revenue growth. This focused approach also can help facilitate negotiations in areas where benchmarking is unfavorable.

Payment Audit

As managed care arrangements continue to grow, the need for monitoring performance is underscored. BKD can perform an audit of your managed care contracts and assess the level of compliance related to payment accuracy, denials, authorizations, quality metric performance, medical necessity and other important terms.

Best Practices

Your managed care department should be following best practices when it comes to monitoring managed care performance. BKD can assist by reviewing charge master updates, assessing clean claims timeliness and evaluating negotiation processes.

Negotiations

Once a detailed assessment for your organization has been completed, you can use the results to help strengthen your position before negotiations begin. If you don’t have an enterprisewide strategy for managed care, BKD is here to help. We can assist in evaluating the level of risk your organization is willing to take in both short- and long-term ranges and develop a customized implementation plan that guides you through the key stages of contract negotiations.

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We have 40 offices in 18 states, with trusted advisors who offer solutions for clients across the country.

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