Many healthcare providers are not equipped with the sophisticated software or appropriate staffing levels necessary to translate each managed care contract and calculate accurate reimbursement. But, with the escalating complexity of contracts, this function is more vital to hospital operations than ever before. CBIZ KA Consulting Services, LLC (CBIZ) has the expertise to enhance managed care payments through expert negotiation, financial assessment, contract language review and review of administrative and medical denials. Listed below are the most common Managed Care Contracting engagements. For more information about a particular engagement, click on the links below or contact George Kelly at (609) 918-0990 ext. 125. Managed Care Contract Negotiation Services Managed Care Payment Audit MANAGED CARE CONTRACT NEGOTIATION SERVICES CBIZ KA Consulting Services offers both hospitals and physicians a variety of expert managed care contracting services that employ proven contracting strategies and tools. Our financial expertise allows us to offer two levels of assistance:
- Development of Strategy and Oversight- Our professionals develop an individualized contracting philosophy, including the identification of key payers to contract with, competitive issues driving the need to contract, evaluation of the employer environment to determine the level of need for contracting and the evaluation of the physician environment to identify future contracting opportunities and pitfalls. CBIZ also provides a variety of analyses prior to and during negotiations, which permit providers to assertively negotiate managed care contracts and evaluate the competitiveness of their rates compared to competitor benchmarks and hospital cost levels.
- Outsource Negotiation- Under this option, CBIZmanages the entire negotiation process with minimal interruption of the finance workflow. CBIZ directs all meetings, data collection and analysis, and is responsible for delivering final rates.
- Detailed contract compliance studies including verification of payment levels, identification of carve-out levels and determination of service definitions used to drive payments. Based upon this study CBIZ performs a successful payment recovery engagement.
- Denial reviews including both the appeal of current medical and administrative denials and the performance of a process improvement program to reduce future denial levels.