CONTRACT REVIEW AND ASSESSMENT
The top five managed care agreements typically
generate 80-90% of a hospital's managed care
revenues. QHR managed care specialists review
those key agreements, focusing on the language
and financial components that will enhance
subsequent contract negotiations for the hospital.
CONTRACT NEGOTIATIONS
If your hospital experiences difficult or complex
negotiations with a specific payor, you may
benefit by having our seasoned contract negotiator
represent the hospital. Your hospital can approach
the contracting process as managed care plans do,
by using QHR professionals with the same skills,
experience, and modeling tools to insure your
facility gets the best possible deal.
REVIEW OF HOSPITAL MANAGED CARE
PROCESSES
Unless key processes and support tools are in
place to accurately implement a managed care
contract, even the best negotiated contract will
never meet its original targets. QHR experts can
insure that your staff has the proper tools to
administer each agreement, including an effective
claims payment validation process and denial
management program.
A QHR MANAGED CARE WHITE PAPER -
"Managed Care Process Improvement Leads
to Increased Net Revenue"
|
RETROSPECTIVE CLAIMS REVIEW -
DENIAL MANAGEMENT SERVICES
Through a vendor partner, QHR can identify retrospective
identification and collection of underpayments by managed
care and commercial payors. Our partner works with each
location on a contingency basis to obtain the additional
reimbursement. These professionals can also represent the
hospital in their denial management activities on an ongoing
basis.
STRATEGIC ASSESSMENT OF HOSPITAL
MANAGED CARE MARKET
Occasionally a dominant managed care plan in a market
is unwilling to negotiate an agreement with a hospital.
QHR consultants can develop and help execute a managed
care strategy to reposition the hospital with other payor
alternatives and recover some lost revenue opportunities.
MANAGED CARE EDUCATIONAL
PROGRAMS
QHR Managed Care Services conducts educational
programs through the QHR Learning Institute that address
emerging issues within the managed care arena.
|