Managed Care Consulting

Managed Care Consulting

Nearly every medical practice has experienced the hassle of contracting with a managed care organization (MCO). In addition to being difficult to decipher, managed care contracts are often full of red tape. Requirements such as preauthorizations, medical record requests, and the like can quickly overwhelm administrative staff. Calculating an accurate reimbursement and tracking late payments can be challenging, too.

Despite these drawbacks, contracting with an MCO can be beneficial to your practice—if the arrangement is governed by the right contract. With a proven track record of successfully negotiating with MCOs, I can help.

What Is Managed Care Consulting?

As your managed care consultant, I offer expert guidance to strategically position your practice to be successful with managed care—in other words, to increase your reimbursements and reduce administrative burdens wherever possible. This generally involves reviewing your existing managed care contracts, conducting a variety of analyses, and negotiating with managed care payers on your behalf.

I can help you answer the following questions:

  • Is your practice being underpaid by managed care payers?
  • What are accurate payment levels for your practice?
  • How can you recover lost revenue?
  • How do your practice’s rates compare to competitor benchmarks and hospital cost levels?


Managed Care Contract Review and Financial Analysis

Not all managed care contracts are worthwhile for your practice. It’s important to understand which contracts are beneficial, and which are putting your practice’s productivity—and profitability—at risk.

Unfortunately, managed care contracts are notoriously complex. Translating and monitoring each one can be challenging for any medical practice. Without a full understanding of the contract, it’s nearly impossible to calculate an accurate reimbursement.

A thorough review of your managed care contracts gives you a clear picture of your reimbursement situation. This review identifies key contract terms such as effective dates, termination dates, claim filing and payment guidelines. It allows me to identify administrative and medical denials and assess reimbursement arrangements.

The next step is to conduct a cost accounting analysis for rate comparison and a fee schedule analysis to identify code-specific reimbursement rates. Analyzing data such as your practice’s percentage of charges and timeliness of managed care payments is critical, too.


Managed Care Contract Negotiation

You may wonder if it’s truly possible to negotiate or renegotiate your practice’s managed care rates. Here’s the short answer: You won’t know until you try.

Armed with insights into your practice and a deep understanding of managed care, I can assertively negotiate with MCOs on your behalf. Whether it’s increasing your reimbursements or removing burdensome administrative requirements, my ultimate goal is to tighten your practice’s revenue cycle while boosting your profitability.

Learn more about Managed Care Contract Negotiations

The Importance of Managed Care Consulting

Managed care contracting isn’t going anywhere anytime soon. For this reason, consider taking steps to ensure your practice’s managed care contracts aren’t doing more harm than good. If you have questions or concerns about your practice’s managed care contracts, please contact me today at 281-379-5988, submit a form online, or email me directly at

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