The future success or failure of healthcare providers of all types and sizes, weighs heavily on the ability to develop a strong managed care contract strategy. More importantly, a provider must leverage themselves into the marketplace by successfully negotiating contracts. Many providers sign contracts with the hope that everything will go in their favor with almost a guarantee that they won’t.
In addition to negotiating good contracts, it is necessary to understand your fee schedule and the impact it can have on the bottom line. Many providers unknowingly undercharge for their services, leaving thousands of dollars on the table, often undiscovered and never collected.
Because this confusing process is very time consuming to keep up with, most providers find themselves at a true disadvantage.
Catalyst Consulting provides top level contract management that optimizes practice billing and accounts receivable from all payor groups based on a “best case scenario” managed care contracting strategy. Our industry experts will help you get the extra edge you need to achieve positive results.
We provide services for Physician Groups of all specialties, ASCs, Diagnostic Imaging Facilities, and other Ancillary providers respectively. We also provide services for any special or unusual contracting needs.
New/ Start-Up Provider or Facility:
- Identify “best case scenario” local market contract strategy with major payors to include PHOs & IPAs
- Assist with the development of CPT codes list, chargemaster and superbill
- Provide a comprehensive billed charge analysis using national and local market standard fees to establish billed charges
- Procure contracts and applications from health plans and follow through to effective date
- Negotiate contracts for appropriate language and reimbursement
- Build complete list of allowables for all contracted payors for coordination with billing department and /or billing company
Established Providers/ Facility (Contract Re-Engineering):
- “Clean-up” provider’s contracting files
- Request new and fully executed copies of all contracts where required
- Perform billed charges analysis to determine codes that are underbilled and adjust for proper charges
- Execute contract performance analysis to determine contract renegotiation opportunities
- Develop new contract strategy for local market
- Identify new contracting opportunities
- Identify payor issues with fee schedules, allowables, etc.
Contract Maintenance Program (Current Clients Only):
- Maintain master fee schedule spreadsheet by updating most current payor reimbursement schedules as they change and are released
- Coordinate updates and changes in reimbursement schedules with billing company or office management for fee schedule in-load into billing software
- Provide ongoing language and fee schedule review for new contracting opportunities as well as existing contracts
- Communicate changes in provider product offerings and identify opportunities for Managed care contract renegotiation as well as new contracting opportunities
- Provide periodic billed charge analysis to ensure that provider isn’t underbilling
