In today’s competitive world, it is imperative for all health care providers; hospitals, skilled nursing facilities, and physicians of every specialty to have a comprehensive portfolio of managed care contracts. In addition to the major insurance companies (i.e., BCBS, Aetna, CIGNA, UnitedHealthcare and Humana), there are dozens of smaller networks and plans that enter the marketplace each year. Does your organization have all of the contracts you need? Are there contracts that you should terminate? Is your organization you well positioned to absorb the coming changes to Medicare and Medicaid (known as “Medicare Replacement” plans, or Managed Medicaid plans)? If you have all the contracts you need…when was the last time someone reviewed those contracts on your behalf? Are you being paid properly? Are you being paid timely? Has your organization conducted an audit of existing contracts and their financial performance? If not, who’s looking out for the interests of your organization?

Important items to watch for in all of your managed care agreements:

  • Payment Terms– how much will you be paid, and what does the contract say about timely payment?
  • Bill Submission– how long do you have to submit a bill; and what happens if you submit late?
  • Claim Denials and Appeals– what are your rights in the event of a denial? What is your success rate for appealing denied claims?

These and dozens of other related issues impact your bottom-line financial performance. Do you need help with managed care? If hiring a full-time managed care staff person isn’t practical for your organization, consider the benefits of a part-time resource!

Cypress Healthcare Consultants will provide a review of your current contracts at no cost to you. For more information, or to submit an online proposal request, visit us at www.cypresshcc.com. If you’d prefer to speak to someone directly, we invite you to call us! You can reach Susie White at (972) 489-2963 or Michelene Cleary at (469) 995-9779.