Managed care companies come to the negotiation table with highly skilled negotiators who are trained to make sure that physicians are paid as little as possible for the services they provide. They know that physicians and practice managers simply don’t have the time to fully understand the intricacies of the contracts they are signing. At Fulcrum Strategies, our goal is to help physicians to succeed in the business of healthcare. We can determine if you are getting fairly reimbursed from the payers, or if there is potential for better rates and contract language. Our team, skilled in contract negotiation strategies, will handle all of your managed care contract negotiations. You maintain complete decision-making control throughout the entire process while we do all of the work.
Before we take on a new client, we want to get a realistic picture of the group’s situation. We look at things that could help or hurt future negotiations – for example; local competition, any unique aspects of the group, and contract language and rates. If we don’t think we can help a particular practice, we don’t want to take their money. To determine if we can help, we will perform a complimentary data analysis of your contract rates. We will ask you to provide us with a utilization report of your top codes with volume and fee by payer, along with the contracts themselves. From the hard data, and our knowledge of the various payers’ practices, we will normalize your contracts to a single year of Medicare so they can be compared accurately to each other, and allow us to identify which contracts can be improved. From there, we will determine how much money could be available if you were to engage Fulcrum Strategies to renegotiate your contracts.
When a group decides to become a client, we’ll draft up Consulting Agreement for your review. Once signed, we begin the negotiation process. We use the previous analysis we performed to organize a “plan of attack.” We recommend which contracts should be negotiated first and predict what the likely outcomes will be. This is a collaborative process and we always defer to the client's wishes. As negotiations proceed, the client is updated as often as they wish. Once the documents are finalized, we keep images of all contracts in our database for future reference. For our clients’ peace of mind, we maintain a calendar of all contractual renewals for as long as the client remains with us.
Alternative Payment Negotiations
The healthcare landscape is changing – especially with regard to how physicians are paid and who pays them. Today, healthcare professionals are being bombarded with new terms like: Accountable Care Organizations, Patient Centered Medical Home, Tiered Networks, Episode of Care, Shared Savings and Pay for Performance, to name a few. Physicians and medical practice managers who don’t fully understand these new payment models could unknowingly sign unfavorable contracts and incur substantial revenue losses.
Now more than ever, you need a trusted ally at your side – someone who has your best interest in mind and who understands these new approaches to reimbursement methods. Fulcrum Strategies is uniquely suited to be your best advocate in these difficult and complex negotiations. At Fulcrum Strategies, our team of former insurance professionals will make sure you are protected before you enter into one of these new agreements. We can help you to understand the frequent changes that are taking place, how they will impact your practice, and how these changes can be tailored to actually benefit your practice.
Contact us today to discuss how we can help with contract negotiation services.