Managed Care Contracting (MCC)

Managing the increasingly complex healthcare reimbursement models is absorbing more of a provider’s resources—with no assurances that contracts are tenable or will lead to financial stability. With the emergence of risk-based payment structures, models and tools that served organizations and managed well for years need to be revisited. Contracting decisions must now take into account your hospital or medical group’s preparedness for value-based reimbursement and clinical integration.

RR Health Strategies (RRHS) has the expertise in all facets of contracting, negotiation, and implementation to do just that to optimize your contract and how you do business with the managed care plans. We offer a complete solution: From pre-negotiation analysis and strategic development to negotiating with the health plan and working to include care management and similar programs through protocol implementation and follow-up.

RRHS Can Assist in the Following Areas:

  • Contract Review

    For strengths and weaknesses, identify gaps in language or multiple/vague interpretations that might result in a payer’s inability or unwillingness to comply with your intent of the term.

  • Recommend Specific Changes

    To improve contract terms, enhancing revenue and protecting providers from denials and other issues.

  • Assist in Developing a Strategy

    To successfully negotiate new agreements and implement a program to ensure contract compliance.

RRHS provides:

  • Strategic planning assistance
  • Creative ideas based on an in-depth examination of information and the objectives of the provider/institution/organization
  • Services to ensure plan implementation is smooth and complete
  • Training support and advice to internal administrative staff
  • Troubleshooting assistance

Before you enter into your next managed care contract negotiation

Contact us