The Providers’ Payer Network™ Claim Negotiation Managed Care Revenue Cycle
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Managed Care
Historically, managed care contracts equaled patient volume and revenue to providers. The managed care landscape is constantly changing and complex because of:• Markets dominated by a few large primary payers;
• Complex & costly administration of MC contracts;
• Declining reimbursement rates;
• Change in payment methodologies;
• Performance based Managed Care contracts;
• New & emerging competitors.
Today, contracts do not equal patient volume or revenues and managed care contracting is an event driven process.
NHPN provides professional consulting services and assistance in several areas, including assessment and modeling of managed care contracts, managed care contract negotiations, and ongoing contract support for health care providers. NHPN assesses current performance and profitability, performs a comprehensive review of all major contracts, develops interdepartmental relationships, and constructs a contract with insurance payers that will meet your strategic needs.
More and more of major primary payers contracts allow access to the $65 billion dollars “Silent PPO” claims paid industry that is unregulated provider discounts. According to the American Medical Association, these contracts, "add no value whatsoever to the health system. They thrive in the health care market that lacks transparency and exist solely to traffic provider discounts. Also, according to the AMA, it may be hard to imaging, that one rental network PPO to have hundreds of other payers and affiliates to whom it "sells" or "rents" various provider panel and associated discounts."
"NHPN provides professional consulting services and assistance in several areas, including assessment of managed care departments, managed care contract negotiations, and ongoing contract support for health care providers. Assessing current performance and profitability, including a comprehensive review of all major contracts, interdepartmental relationships, and contract profitability and develop a contract with insurance providers that will meet your needs." — Holy Cross. Fort Lauderdale, FL