Health Services Contracting
We have experience in all aspects of healthcare contract negotiations. Our team includes experienced insurance executives, health plan and managed care leadership, financial team and corporate leadership. We work hand in hand with our clients to generate the results desired. HRG specializes in the negotiation of managed care and health services delivery contracting. Our knowledgeable team has a proven track record of optimizing our clients’ reimbursement rates, delivering substantial revenue gains and fostering an improved working relationship between the practice and their network, health plan or managed care organization.
- Evaluation to define Strategy: We analyze each prospective client’s current managed care utilization data and payer relationships allowing our team of negotiators to assess the prospects of increased reimbursement and improved contract provisions, as well as determine the best way HRG can provide value during negotiations. A contracting strategy and action plan is defined.
- Solicitation & Timetable: The firm uses project management software to monitor a contract from initial solicitation up to and including the date the executed contract is received by from the contracted organization. The project management software allows for tracking of notes, issues, and tasks necessary to ensure timely follow-up and monitoring of progress.
- Contract Review: The HRG Contract Language Guide allows for consistent and thorough summary of a contract; highlighting areas of concern, including elements excluded in an agreement. The use of the summary document enables consistency among varying templates used by payers resulting in an easier review and understanding of obligations and responsibilities for our clients. Elements of the review include plan responsiveness, administrative requirements, payment issues, quality assurance, medical management, legal issues and risk management issues.
- Negotiation: We take on all aspects of the negotiation process attaining un-paralleled results, while keeping the client involved and informed. Throughout this process we ensure that our process and status of deliverables is transparent to our client. Communication is the key to success. Knowing the interests of a network, health plan or managed care organization as it relates to the services provided by the practice helps leverage a negotiation (i.e. reduce costs, over utilization, access, outcomes). The attitude toward the practice by the payer is assessed during initial meetings. All negotiations are approached as a partnership between the payer and the practice.
- Monitor Results: Following the executed agreement, we continue to provide full support in all areas of the newly negotiated contract. The support ensures that the negotiated terms are adhered to by all parties, allowing our client to focus on running their organization successfully. Our firm manages any renewals, rate change notifications and serves as a liason for our clients in working with the various organizations.