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.
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.
To improve contract terms, enhancing revenue and protecting providers from denials and other issues.
To successfully negotiate new agreements and implement a program to ensure contract compliance.