Got managed care?

By admin user

Published on October 6, 2019

In Blog Posts

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!

We would love to talk with you about questions you need to ask about your managed care contracts. Give us a call anytime or use the handy proposal submission tool on our website to get in touch.