Contract Performance Evaluation

Contract performance: affecting every aspect of your business. 

Contraction negotiation with the various payors isn’t always a “take what you get” proposition. Understanding the nuances of these contracts is critical. Maximizing the revenue from your various payor contracts is essential. And it’s hard. Really hard.

Our experienced staff will review your practice’s current agreements to:

• Verify the accuracy of claim payments based on contract expectations.
• Ensure key contract provisions are included.
• Identify potential loopholes in agreements which may prevent or reduce payments.
• Assist in the credentialing process, ensuring that all providers receive appropriate recognition and payment.
• Evaluate and recommend which additional payors may be a suitable and profitable fit.
• Help you determine the contract negotiation parameters for the “best deal” to enhance your practice revenue.

From well-established practices to those just starting out, we always begin with a practice assessment and root cause analysis of your position in the marketplace to answer the following critical questions:

• What are the pay rates of the existing contracts for the practice?
• What are the gaps or deficiencies in the current contracts for the practice?
• Are the practice’s current contracts accurate? Is the practice is being paid properly?
• Is the level of service provided by the practice coded accurately and paid accordingly by the payor?
• Are your practice physicians eligible for performance payments?
• What are the claim denial trends? Are these opportunities for improvement or further contract negotiation?

“Not a penny more and not a penny less.”

This is the philosophy we follow when negotiating contracts on your behalf. Your practice and providers deserve the rate appropriate for the level of care and service you provide.

Once we’ve completed a review of the existing contract background for your practice, we’ll deliver specific and strategic recommendations, including:

• Value-based payments for services – our contracts differentiate with payors to maximize reimbursement.
• Contract selectivity – purposefully choose which lines of business contractually make the most sense with which payors.
• Strategic contract negotiation and review – helping our clients differentiate from their colleagues and put their best foot forward with payors.

We take pride in offering our clients (no matter their size or position in the marketplace) innovative and efficient ways to contract with payors. In our experience, taking any contract that comes through the door without strategy, scrutiny and negotiation can be detrimental.