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Payer Contracting
Partnering for Success

Most practices do not have the time or resources to review contracts in detail, compile and analyze meaningful performance data, and monitor their financial impact.

This could cause significant losses due to untimely claim submissions and appeals, increased work for staff and automatic renewal of unprofitable contracts.

In today’s healthcare environment, the average medical practice signs numerous contracts with managed care organizations and insurers. Many of these contracts contain provisions that hamper a practice’s ability to obtain adequate reimbursement, unduly restrict billing and appeal timeframes, allow unnamed, non-contracting organizations to discount reimbursements to your practice, and expose your practice to unnecessary liability and loss.

MDmanagement will gather, review and summarize core contract and performance information for each payer and insurance product. The contract information will be prepared and presented in a summary matrix format for your quick reference, and a separate, more comprehensive summary will be prepared for each payer. MDmanagement will update all pertinent contract information quarterly to ensure all key staff members are working with the latest information. MDmanagement can also provide expert consultation about contract modifications, negotiation strategies and other contract issues.

Core contract information includes:

  • Payer contact name, address, telephone and email address
  • Term of contract
  • Rate methodologies by service w/date of last revision
  • Time limit to submit initial claim
  • Time limit to make payment determination
  • Time limit to appeal denied claim
  • Network affiliates and other covered entities

Performance Information Includes:

  • Average insurance payment percentage relative to gross charge
  • Average lag time from claim submission to receipt of payment
  • Average patient responsibility per paid claim
  • Average volume and charge amount of claims denied
  • Denial breakdown per category
  • Key considerations for improved performance and profitability

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