|
managed care contract analysis
Do you know what your managed care contracts are supposed to pay and are they paying you what they should?
Your insurance contracts determine your practice's financial success. Managed Care can comprise from 25% to 85% of your bottom line. With this much at stake, physicians must be careful to choose contracts which cover the actual cost of providing patient services. We have the industry expertise to review contracts for these pertinent details. In addition, we utilize the nationally recognized RBRVS based system to analyze if your fees are in line with what they should be. Chances are a number of them are less than the going rate for reimbursements.
Using comprehensive RBRVS software, we run five valuable analyses:
- A procedure code analysis determines if all the procedure codes being used are valid.
- A fee and reimbursement analysis by each procedure code.
- A percentage based comparative analysis of managed care fees in relation to local Medicare carrier fees, weighted for utilization for managed care negotiations.
- An evaluation and management utilization review to compare your practice's utilization to the national utilization statistics for your specialty.
- A break-even analysis on the entire charge profile or on specific procedures being added to the practice.
Using this analysis, we can increase fees to maximize allowable fee amounts per your managed care contracts. We also advise the practice on how to balance procedures and items which may be paid less than what it costs the practice to provide the service to their patients. In many instances, we are able to identify payors which are undercutting your reimbursements and cutting into your profits.
Contract Negotiation
With our experience, knowledge and industry contacts, Kerkering Barberio can help you navigate the maze of managed care contract negotiation. Based on our reimbursement analysis, we are able to negotiate more appropriate contract rates to ensure that you are not losing money on services provided. We accomplish this by recommending an overall rate increase to a payor contract or by proposing "carve outs" for services specific to your practice.
|
