Managed Care Contracting Services
Navigate complex contract negotiations and compliance challenges more effectively with Invensis's managed care contracting services. We offer customized solutions that meet your healthcare practice's unique needs, ensuring contracts are structured to achieve maximum financial benefits and strategic alignment.
Years of Experience
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Streamline Managed Care Contracting Services with Invensis
Managed care contracting is the process of negotiating agreements between healthcare providers and insurance companies, outlining the terms for services, reimbursement rates, and compliance requirements. These contracts determine how much a practice will be paid for the services rendered to patients covered by a specific insurance plan. Managed care contracts are crucial for maintaining a healthcare organization's revenue cycle, ensuring financial sustainability, and establishing relationships with payers. However, they can be complex, involving varying healthcare reimbursement models, legal terms, and regulatory compliance standards that differ across payers.
Negotiating favorable terms is often challenging for internal teams due to a lack of specialized knowledge of payer strategies and market dynamics. Practices also fail to comply with contract regulations and reimbursement terms. Managing contracts with multiple payers adds administrative burdens, requiring careful attention to avoid errors, discrepancies, or compliance violations. If contracts are not properly managed, these challenges lead to underpayment, delayed reimbursements, disputes, or financial penalties.
Invensis, as a leading managed care contract service provider, helps healthcare practices overcome the above challenges, reduce administrative strain and improve their position in the following ways:
- Conducting a comprehensive contract review to assess current reimbursement methodologies, fee schedules, and regulatory compliance requirements within existing managed care agreements.
- Performing a gap analysis to identify risks such as underpayment trends, outdated reimbursement clauses, or contractual language that may not align with current payer policies or market standards.
- Developing a strategic plan for contract negotiation or renegotiation, incorporating insights from payer mix analysis, market dynamics, and payer-specific strategies to secure higher reimbursement rates, modify fee-for-service models, or implement value-based care arrangements.
- Drafting customized managed care contracts that incorporate the negotiated terms, including alternative payment models (APMs), bundled payment structures, and updated compliance clauses aligned with the organization's strategic objectives.
- Performing ongoing regulatory assessments to ensure contracts comply with federal and state healthcare regulations, such as Stark Law, Anti-Kickback Statute, and HIPAA requirements, with regular compliance audits to proactively address non-compliance risks.
- Assisting in integrating new agreements by updating internal systems, billing workflows, and electronic health record (EHR) configurations to reflect new contractual terms.
- Training staff on new reimbursement policies, prior authorization requirements, and payer documentation standards to ensure adherence to contractual obligations.
- Monitoring payment cycles and payer performance metrics to identify and address underpayments, pursue denied claims appeals, and adjust contractual terms in response to market shifts or payer policy updates.
- Providing detailed contract performance reports utilizing predictive analytics and key performance indicators (KPIs) to forecast potential payment issues and recommend strategic improvements for future contract management.
- Managing communication with payers to facilitate dispute resolution, negotiate contract amendments, secure retroactive payments, and ensure continued financial stability in compliance with payer agreements.
Our Comprehensive Managed Care Contracting Services
- Contract Negotiation for Healthcare Providers and Development
- Pre-authorization
- Case Management
- Utilization Management
- Payer Relationship Management
- Health Plan Contract management
- Per Diem Payment Services
- Compliance Monitoring and Regulatory Guidance
- Stop-Loss Insurance Services
- Reimbursement Rate Negotiation
- Case Management Services
- Performance Measurement and Benchmarking
- Value-Based Care Strategy Implementation
- Fee-for-Service Contracts
- Telehealth Contracting Support
- Claims Management and Reimbursement Optimization
- Training and Education for Internal Staff
- Risk-Sharing Arrangement Structuring
- Social Determinants of Health Integration
- Provider Network Agreement
- Medical Necessity Review
- Bundled Payment Agreements
- Behavioral Health Contracting Support
- Population Health Management Strategies
- Chronic Care Management Program Development
- Dispute Resolution and Appeals Management
- Credentialing and Provider Enrollment
- Technology Integration and Support
- Market Research and Competitive Analysis
- Customized Healthcare Contracting Solutions for Specialty Services
- Continuous Performance Improvement Initiatives
- Patient-Centered Medical Home (PCMH) Support
- Outcomes Tracking and Reporting
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During your consultation, some of the issues we can discuss are:
- Current managed care contracting process, inefficiencies and opportunities for improvement and optimization.
- Effective techniques for securing better reimbursement rates and more favorable contract terms.
- Strategies to build and maintain strong, collaborative relationships with payers for enhanced support.
- KPIs to assess and track the success of your managed care contracts effectively.
Why Choose Invensis As Your Trusted Managed Care Consulting Company?
Invensis is a leading managed care contracting service provider among healthcare organizations worldwide, including hospitals, specialty clinics, and physician practices. We specialize in comprehensive contract negotiation, payer relationship management, and compliance oversight and ensure that your organization secures effective terms while navigating the complexities of managed care agreements. Our seasoned managed care contracting team analyzes existing contracts, implements value-based care models, and enhances reimbursement strategies, which leads to improved financial performance. By utilizing our expertise, our clients have reported a 75% reduction in contract turnaround time and an 80% increase in reimbursement rates.
Here are the key benefits of outsourcing managed care contracting services:
- Expertise in Negotiations: Managed care negotiations involve complex discussions with payers to establish reimbursement rates, contract terms, and conditions. Internal teams may lack the depth of knowledge needed to navigate these intricacies effectively.
Outsourcing to a healthcare contracting service helps healthcare organizations gain access to specialists who thoroughly understand payer strategies, industry benchmarks, and evolving regulatory requirements. These experts can anticipate payer tactics, identify opportunities for better terms, and craft negotiation strategies that achieve optimal financial outcomes. - Streamlined Dispute Resolution: Disputes with payers can be time-consuming and disrupt cash flow, especially when internal teams lack experience handling payer conflicts. Delays in resolving disputes can strain relationships and lead to significant financial setbacks.
Experienced managed care contracting services bring expertise to dispute management, allowing for quicker and more efficient conflict resolution. Their skills in negotiation and payer communication help minimize disruptions, ensuring disputes are settled promptly and positively. - Customized Providers Network Contracting Solutions: Standardized contracts may not adequately address a healthcare organization's unique financial and operational needs. Internal teams may find it challenging to customize agreements to optimize reimbursement and align with strategic goals.
Outsourcing to managed care contracting companies provides tailored contract solutions that meet the specific needs of healthcare organizations. These experts structure agreements to maximize reimbursement potential while supporting long-term objectives. Customizing contract terms, reimbursement models, and compliance metrics ensures that contracts benefit the organization and are adaptable to its strategic direction. - Enhanced Contract Compliance Audits: Internal teams find it daunting to keep contracts aligned with current regulations and payer requirements, especially given the constantly changing healthcare regulatory environment. Failure to maintain compliance can result in penalties and reimbursement issues.
Specialized managed care contracting services conduct thorough compliance audits of existing contracts, ensuring that terms align with the latest regulations and payer policies. This proactive approach minimizes the risk of penalties and financial losses by identifying and addressing compliance gaps before they become problematic. - Multi-Payer Strategy Execution: Managing contracts across multiple payers adds significant complexity to administrative tasks, making it challenging for internal teams to ensure consistent strategies and compliance across different payers. This can lead to inefficiencies and errors.
An outsourced managed care contractor brings multi-payer expertise, implementing consistent strategies across all payer contracts to maximize reimbursement and streamline administrative processes. Their coordinated approach reduces administrative burdens and ensures compliance with each payer's requirements, allowing healthcare organizations to focus on patient care rather than contract management. - Increased Competitive Advantage: Competing in the healthcare market is difficult when internal teams struggle with inefficient contract management and negotiation processes. Organizations may be disadvantaged compared to competitors who can secure better reimbursement terms.
When healthcare practices outsource managed care contracting services, the experts help them with enhanced contract negotiation outcomes, improved payer relationships, and operational efficiencies, positioning the organization effectively against competitors. This strategic advantage allows for better financial performance, reinvestment in growth initiatives, and improved patient care.
Here are the latest trends in managed care contracting:
- Social Determinants of Health: Contracts are beginning to address social determinants, acknowledging their impact on health outcomes. Payers are incentivizing providers to incorporate community resources into care plans, improving patient engagement and reducing disparities by targeting non-medical factors affecting health.
- Data Sharing Agreements: As data-driven decision-making becomes essential, managed care contracts are incorporating robust data-sharing provisions. These agreements facilitate real-time access to patient information, enhancing care coordination and enabling providers to make informed decisions based on comprehensive patient data.
- Risk-Sharing Arrangements: Managed care is increasingly utilizing risk-sharing models where providers share financial risks and rewards based on performance metrics. This trend aligns provider incentives with patient outcomes, fostering accountability and focusing on effective care delivery.
- Enhanced Care Coordination: Contracts now emphasize care coordination among providers. Managed care organizations are incentivizing collaborative efforts to streamline patient transitions across various care settings, reduce readmissions, and improve overall patient management through comprehensive care teams and advanced managed care contracting software.
- Patient-Centered Medical Homes (PCMH): The PCMH model is gaining traction in managed care contracting. Contracts increasingly recognize and incentivize practices that provide comprehensive, patient-centred care, promoting better health outcomes through coordinated services and continuous patient engagement.
- Bundled Payment Initiatives: Managed care is adopting bundled payment models, where providers receive a single payment for a patient's episode of care. This approach encourages efficiency and quality, as they are responsible for the total cost and quality of care provided.
What Our Customers Say
Invensis has been a great partner providing quality medical coding and billing services. The team is extremely responsive to every query we pose, and the turn-around time for deliverables is always as committed.
Invensis has been our revenue cycle management healthcare outsourcing partner for the past 5 years. They have always delivered on their commitments, whether it is meeting our Service Level Agreement (SLA) or improving our billing process.
We have been working with Invensis for the past two years, and they have helped us overcome many revenue cycle management challenges. The team often walks the extra mile to ensure that our needs are met.
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