Our approach to contracting is strategically focused. We believe that an effective contracting process involves the data analysis to understand how claims are being paid currently, the administrative issues encountered with a payer, and evidence of Market rates available. We will review the providers current contracts to ensure maximum reimbursement, effective contract language, and appropriate market place.
Our ongoing support is intended to emulate the use of an internal managed care department for the health system. Typically, we maintain payer relationships and initiate any contracting discussions. While the client can choose to be involved to the degree desired, SHP usually conducts payer negotiations directly with the payer, and then informs the client as to outcomes, recommendations, and next steps. In addition, SHP typically maintains all current agreements and owns the process of validating contract performance and initiating negotiations/re- negotiations.
Certainly contract language and reimbursement rates are the driving force behind a payer’s payment structure. However, overall reimbursement is affected by charge levels, charge capture, clinical coding, as well as billing, payment posting, and appeal processes. Additionally, aging managed care contracts may lack mechanisms that allow for appropriate reimbursement for new services, new locations and chargemaster increases.