Dramatic changes in the economics of providing healthcare have created an increased reliance on healthcare contract management agreements, which has afforded Elevate the opportunity to ensure that our clients are getting paid appropriately according to their managed care agreements. Gone are the days when physicians could simply trust that they were getting paid fairly and accurately or in accordance with your executed healthcare contract. The reimbursement rate is only one piece of the puzzle. Often times there are not only marketing, service and accessibility issues, but there are also other elements such as precisely defining what benefits are covered, stop loss provisions, various incentives and provisions about how members are counted and properly allocated. Healthcare contracts are legal binding documents which need to be reviewed carefully. Many physicians sign contracts without challenging or negotiating payor rates.
Contracting with payors is not just a one-time event and then out of mind. Healthcare contract management involves performing an annual analysis. For instance, identifying your top 5 payors- what is the current reimbursement rate per your healthcare contract? What is the volume by patient encounters and revenue by the payor?