PAYOR CONTRACTING/MEDICAL CONSULTING 

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Payor Contracting* (*Results for Sampling of 50 clients – Q2/3)

• 9.5% Average Fee Schedule Renegotiation Increase

• 100% New Contract Approval Success Rate

• 23% Client Revenue Increase per Month

• 14.7% Client Market Exposure Increase for Patient Intake

• 90 Days Average for Project Completion

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Insurance Contracting/Credentialing - Whether it is reviewing insurance contracts, re-negotiating fee schedules or requesting brand new group contracts, our team is here to ensure that the right plan and tier schedule is selected. Based on years of maintaining solid relations with major insurance carriers, rest assured your plans will be the most up-to-date, maximizing each dollar for reimbursement. We also efficiently credential all clinicians and techs in a timely manner and keeping them compliant. We pride ourselves in credentialing and approving applications in fewer than 14 business days. In many cases, that is 80% less time than the standard facility or group with their internal Medical Staff Office.

 

Payor Contracting:

Payor Contracting can be clearly defined as a primary root cause for RCM/ claim errors or reimbursement deficiencies. Specific to laboratory services, this workflow disruption can cause significant loss in revenue over time due to samples simply being run for free due to incomplete eligibility checks, or payor verification confirming in network participation. 

 

Payor Contract Renegotiation:

Payor contracts that are in network but dated can be a hinderance for any lab’s growth and profitability tracking. Are these plans maintained regularly, ensuring fee schedules are in line with competitive rates? If not, there is a likelihood that a percentage of collections will not be correctly reimbursed and/or become uncollectable based on the carve-out plans that may not be in line with an updated current testing menu.

 

Coding/Auditing: 

We have found that most of our clients’ challenges stem from credentialing and revenue audits. With each audit review, our team evaluates collections over time, offering helpful suggestions and tools to optimize the billing and collections process.

 

Medical Consulting: Clinical / Laboratory / DME/ Pharmacy:

Even with checks and balances in place, a claim submitted is only as good as the documentation that supports it. Efficient laboratories can demonstrate dialed in processes that validate medical necessity. Streamlined communication with physician referrals who understand the importance of complete and timely documentation is mandatory for long term stability. Guidance, education, and training is ongoing and recommended as regulations evolve and payor standards become more stringent.  Because we are managed by a team of clinicians and business experts, we know where to look to find the holes in the system. We are highly experienced and recognized for providing detailed assessments to aid in the development and implementation of top and bottom-line revenue enhancement initiatives.