Contracting & Managed Care

Recent Service Engagements

An organizations financial performance rests largely with the health of its reported net patient revenue. The majority of today's patients have benefit plans for which the healthcare organization has the responsibility to have effectively negotiated optimal rates and maintain those systems that ensure accurate computation of net patient revenue, a function of rate term and volume by service, across all benefit plans. Many factors come into play. Successful contract negotiations are as much an art as a science that require an essential knowledge of internal unit costs, market rates and trends, current profitability by service or program, strategic imperatives, payer relationships and issues, physician practice patterns, and compliance mechanisms, to name a few. These matters pertain to fee-for-service as well as risk-based arrangements.

HFA professionals have years of experience with hundreds of successful negotiations and effective management of revenue systems as practioners in assuring maximum and accurate net patient revenue. Our advisors have prominent knowledge and experience in all facets of managed care operations with both provider-side and payer/intermediary-side responsibilities.

• Administrative Restructuring
• CDM/Pricing Management
• Contract Compliance Review
• Contracting Strategies
• Contract Systems Development
• Financial Strategies Planning
• Managed Care Strategies
• Mediation & Negotiation
• MSO Management & Operations
• Regulatory Compliance
• Revenue Cycle Compliance Management
• Risk Contract Optimization
• Risk Performance Reporting

Recent Service Engagements

• Teaching hospital start-up MSO development including contracts, systems, policies and practices, reporting systems, inter-organizational relationships, and management standards.
• Led contract negotiations for large national insurance organization.
• Directed emergency and oversight services to insurance organization membership in out-of-network hospitals.
• Numerous engagements significantly reducing medical loss ratios and improving risk-based contract performance.
• Lead negotiator for numerous successful commercial and managed care contracts.
• Designed and negotiated effective managed care contracts including the appropriate supporting analysis, contract rate review, and rate structure modeling.

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