CONTRACT PERFORMANCE EVALUATION
Depending on the nature and scope of a physician practice, your contracted rates with payors can affect every aspect of your business. Contraction negotiation with the various payors isn’t always a “take what you get” proposition and understanding which contracts your practice can benefit from is essential. Is your practice maximizing the revenue it can receive from your various payor contracts? Understanding the nuances of these contracts is critical to capitalizing on revenue opportunities. Our experienced staff will review your practice’s current agreements and verify the accuracy of claim payments based on contract expectations, ensure key contract provisions are included, and identify potential loopholes in agreements which may prevent or reduce payments. Working with your office staff, we can also assist in the credentialing process, ensuring that all providers in a group receive appropriate recognition and payment for services.
In addition to assessing existing payor contracts, Zymeda offers expertise in evaluating and recommending which additional payors may be a suitable and profitable fit given the scope of your practice – then helping 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 as well as the existing contract landscape 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? – Ensuring the practice is being paid by the rate that was agreed to.
- 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 with those payors offering such opportunities?
- What are the claim denial trends and are these opportunities for improvement or further contract negotiation?
When it comes to effective contract negotiations, we govern our actions on clients’ behalf by the philosophy: “Not a penny more and not a penny less.” Your practice and its providers deserve the rate appropriate for the level of care and service you provide. At Zymeda, we pride ourselves on 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 strategically determining whether it’s a right fit for your practice can be detrimental to your business. You really don’t need to take what you can get and contract negotiation for a better deal is almost always possible. Once we’ve completed a review of the existing contract background for your practice, we’ll deliver specific and strategic recommendations to put you in the best position to negotiate contracts that make sense and help make your practice profitable, 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.