Solutions

The contract controls and sets the stage for a successful, fair and reasonable relationship with payers. Your staff usually has more immediate tasks to handle and reviewing and assessing your current contracts is pushed down on their to-do list. Before you know it, months or years have passed and you're not getting paid what you are entitled to. We help you maintain a productive relationship with each Payer by analyzing, comparing and re-negotiating your current and future contracts.

OUR PROCESS

STEP 1: MARKET ANALYSIS

Understand the perception of your organization in the market

• Identify:
• Local employers and # of covered lives
• NJ Workers’ Compensation Provider Networks for top
• employers Controlling Managed Care entities
• · Recognize your organizational and service line strengths
• Assess competitors strengths and weaknesses

Your Organization’s Performance

• Review your organization’s workers’ compensation financial performance by payer for both hospital emergency services, inpatient hospital services, out-patient hospital services, surgical center and physician services (e.g., contract payment yield, profit margin)
• Identify current workers’ compensation contracts for admitting providers
• Review and analysis of “one-off” negotiations both pre and post-procedure/service
• Analysis of current on-staff providers network affiliation by specialty
• Review the rate structures, rates, and financial performance by payer against benchmarks

Managed Care Payer’s Performance

• Assess each payer’s financial performance
• Identify trends by payer

STEP 2: DEVELOP A STRATEGY

Based on the market analysis.

Pricing and Rate Strategy

• Assess each payer’s payment rates to determine the highest and lowest payers
• Establish minimum and target increases over a two-to-three-year period. Identify lowest rates your organization is willing to accept over the negotiated time period per service
• Choose which payer contracts need to be negotiated and which should not be negotiated
• Negotiation rationale to determine network’s desire to secure contract with entity
• Evaluate the following to boost your position relative to workers’ compensation services before entering into negotiations:
• Organizational strengths, weaknesses, and reputation in the marketplace
• Quality of care
• Recent service line and capital investments
• Unique services provided and/or services that no competitors provid

STEP 3: CONDUCT CONTRACT NEGOTIATIONS

Identify the key stakeholders in the negotiation and develop a resource deployment and communication plan.

• Determine the negotiating team (e.g., managed care leaders, revenue cycle, finance, data analytics)
• Identify key stakeholders to be informed of milestones
• Utilize stakeholders for support in strategy development and input in decision-making (e.g., physician and administrative leadership, managed care, finance, legal counsel, medical group leadership, hospital board, marketing/ communication)
• Enter into contract negotiations with network within the parameters established for each entity under control of ________

Accurate reimbursements for our clients is one of our top concerns at Provider's Liaison. We continually analyze the returns you receive from payers to insure it meets your contracted, negotiated rates. We'll periodically review and analyze your accounts receivables, evaluate and collect previously undetected payment opportunities to get an accurate reimbursement from every submission.