HMOs, PPOs, IPAs -- and a whole alphabet soup of others -- make up the managed care options
that exist today. The commitment of time necessary to negotiate successfully with these entities
is often overwhelming for the health care provider. MBS has the people and the experience to
assist you in these negotiations, assure you the most beneficial results from your managed care
contracts, and allow you to devote your valuable time to your patients.
Listed are some of the services routinely provided by MBS in Managed Care Consulting:
- Establishing the actual ownership of the managed care organization and determining
that the entity is financially sound;
- Negotiating the type of reimbursement -- per diem, fee schedule, capitation, etc.
-- offered;
- Assuring that there are no "withholds" beyond the discount agreed upon;
- Determining patient responsibility for non-covered services, as well as co-pays
and deductibles;
- Tracking managed care payments to verify the correctness of the reimbursement rate;
- Evaluating the appeals process in case of disputes concerning payment issues, utilization
review, and medical necessity; and
- Confirming the length of the contract, the renewal process, and the termination
options.
Our considerable experience in representing our clients in this arena has prepared
us to assure you the most beneficial relationship possible with those managed care entities
with which you choose to contract. |
