Value-Based RCM Presents "Managed Care Contracting Part I"

Updated: Feb 3

What is your Managed Care Contracting strategy? If you struggle to answer this question, you need an advocate to support you.

For most healthcare providers, the key problem associated with managing a wide range of payor contracts lies in the complexity of the process. Most providers are working with several different payors at once, with each contracted payor operating under their own terms.

Are you struggling with any of the following common payer issues?

• Outdated agreements with poor payment terms

• Disparate rates between payors for the same or similar services

• Wide range of regional and national network participation, with specialty panels routinely close

• Ongoing changes to billing requirements for reimbursement with little transparency

• Contract language that is confusing and exclusive to each payor

Value-Based RCM brings decades of experience with managed care contracting and renegotiation.

Our work in more than 20+ states across the nation has enabled us to build relationships with major health plans in multiple regional markets, leading to insights and proficiency we bring to every client engagement.

Value-Based RCM provides:

• Planning session with providers to identify current contract performance

• Evaluation of current contract terms and conditions to identify opportunities for improvement

• Determining future payer contracting and goals

o Initiating application

o Subsequent status tracking

o Credentialing

o Fee schedule negotiating support

o Letters of consideration, when applicable

o Coordinating facility on-site visits

o Clearly articulating the clinical value propositions defending higher reimbursement and negotiating lesser administrative tasks (i.e., authorizations, medical record requests etc.) as a “center of excellence”.

• Exploring alternate reimbursement methodologies

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