MANAGED CARE CONSULTING

We provide expert consultation and analysis on various managed care issues.

 

 
     

  •  Audits – We review your Zero Balance Commercial accounts for potential underpayments caused by errors in: Managed Care Contracts, CDM, and PFS system(s). We validate the billing codes (e.g. DRGs, CPTs, ICD9/10s, etc.) listed on contracts to make sure they are current and consistent. Once underpayments are identified, we collect the from the health plans. We provide monthly reports that identify the errors and make recommendations to maximize reimbursement. We work on a contingency fee so there is no risk or loss to hospital.

  •  Collections – We perform managed care collections from early outs to insurance underpayments. In addition to collections, we perform audits and provide recommendations to minimize billing errors and insure maximum reimbursement.

  •  Denials – We perform reviews of all your Commercial accounts that have been denied clinically and/or contractually.

  •  Rate/Fee Analysis – We analyze your current contracted rates and offer optimal alternatives based on existing and projected payor volume.

  •  Payor Negotiations – To assist in negotiations, we provide various reports that compare key contractual terms and rates among all contracted payors.

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