What they do
Hospital Payer Contracting.
This company secures significantly increased rates from insurers for hospitals.
Why it's the Best
Their depth of expertise, advanced proprietary technology and impressive track record of success-
after-success puts them at the top of the consulting pyramid.
Major payer organizations are at the top of an extremely positive underwriting cycle. Insurers are
reporting record earnings growth. While payer profits are soaring, hospital costs continue to rise.
The cost of personnel, drugs and new technologies has created huge financial burdens for many of
our nation’s hospitals and health systems. Reimbursement from government programs continues to
create revenue shortfalls. Your greatest opportunity for financial stability is the maximization of
payment received from private payers.
There is a solution . . .
The outsourcing of managed care contract negotiations to our partner company provides your
hospital with the nation’s premier contracting firm. The unique expertise of this company has
resulted in payer contract rate increases that are usually between 15% and 30%.
The process begins with the development of a data repository. Your hospital’s claims submission
history is utilized to provide a baseline assessment/analysis that leads to the development of
financial projections and contract models. The company representative actually comes to the
negotiating table with your team, loaded with information about the payer’s history with your
organization, as well as detailed comparative information and trends assembled from local, regional
and national sources.
The powerful benefit of this service is often the tipping point between positive and negative financial
Overview of activities:
- Provide a contract review, including financial and non-financial provisions
- Conduct data acquisition of charge, reimbursement, and other payor performance
information by Payor
- Collect, centralize and maintain a working database of all payor contracts
- Development of Payor Contract Grid outlining key business and financial terms
- Review of aggregate Charge Master levels by service type
- Reimbursement Analysis by service type to analyze Payor Contract Yield and general
- Review and analysis of key financial indicators, including a benchmark analysis using
proprietary data base and other market based comparative data
- Analysis of Hospital’s market position and leverage
- Modeling of data using proprietary models
- Establish Projections based on the modeling, benchmarking, market position and other
analyses, as applicable
- Prepare proposal(s) for delivery to Payor(s)
- Review contract yield projections and proposals with Hospital Management
- Deliver proposal(s) to Payor(s)
- Contract language and financial terms are negotiated with the Payor(s) with real-time
- Hospital Management approves negotiated reimbursement and contract language changes
- Final contracts and/or amendments are prepared for execution by Hospital Management
- A matrix is developed with new contract terms for ongoing contract management