Importance of Managed Care of Contracts
Managed care contracts play a pivotal role in ensuring efficient delivery of behavioral healthcare while remaining advantageous to the financial standing of your practice. These contracts wield substantial influence over the daily decision-making processes of behavioral healthcare providers by delineating the scope of services they can extend to patients. The ramifications of negotiations transcend mere payor-provider relations, molding the availability, and costs of various healthcare services.
Understanding that behavioral healthcare providers may find themselves overwhelmed or lacking the resources and time to negotiate favorable terms with health plans such as Medicare and Medicaid. Our boutique services serve as a conduit, leveraging our proficiency and experience to facilitate reciprocal and profitable agreements between payors and providers.
How Secure Contracts Help Your Practice
Improved Capacity
Our team enhances your ability to analyze and monitor your contracts effectively, so you can still manage and understand what’s happening behind the scenes.
Increased Revenue
We’ll help you boost your reimbursement rates by securing more competitive contract agreements so you can focus on patient satisfaction.
Data-Backed Negotiations & Renegotiations
Our extensive database of market rates and established relationships with payors and health plans can help negotiate and renegotiate terms backed by solid data and reputation.
Effortless Communication
Our extensive connections and contacts ensure quick and efficient results without unnecessary delays or complications for your practice.
Assessing Your Managed Care Contracting Needs
Prior to Reveloop embarking on contracts and negotiations, we conduct a comprehensive assessment of your organization and the prevailing market landscape. We guide behavioral healthcare providers through this preliminary process, scrutinizing key areas and addressing fundamental questions
Your Practice's Market
We delve into understanding your organization’s services and their perception in the market and by the general public. We scrutinize your strengths, recent investments or enhancements to services, and any accolades or awards. By evaluating other practices and providers, we ensure you stay updated on changes implemented by competitors.
Your Performance
Reveloop rigorously analyzes your practice's financial performance with diverse payors, encompassing payments and profit margins. Comparing rate structures, rates, and performance, we formulate a strategic plan based on internal and external benchmarks. This process aids in recognizing significant service changes and objectively evaluating your values.
Existing Care Contracts
We scrutinize current contracts, analyzing rate changes, trends, and adjustments stemming from payor operations. This provides insights into any surge in denials, reduced authorizations, or modifications in payment rates. We also monitor and scrutinize contract language for opportunities to enhance terms and lower costs.
Payor's Performance
Lastly, we evaluate the financial performance of each payer, both within and outside your network. This allows us to identify adjustments in trends displayed by payers, such as premium increases, profitability, and fluctuations in membership.
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Strategizing Managed Care Contracts
Once Reveloop comprehends your needs and objectives, we collaborate with you to devise strategies and opt for or renegotiate contracts that enhance your financial standing.
Pricing & Rate Strategy
We initiate by evaluating payment rates from each payer to pinpoint the highest and lowest payers. This allows us to determine necessary rate increases required to achieve parallelism within managed care contracts, considering market-competitive rates if available. We then establish minimum and target rate increases, defining acceptable desired rates and identifying which payer contracts should be negotiated for better terms while determining contracts that can remain unchanged.
Product Strategy
Reveloop aids in defining pricing targets and essential requirements (e.g., pricing, contract language) for different products and plans like HMO, PPO, Medicare Advantage, Medicaid, and others.
Time Frames
Reveloop underscores the importance of prioritizing payer contracts based on payment rates, net payment, profitability and market share. Collaborating closely with behavioral healthcare organizations, we determine the optimal timing for initiating negotiations with each payer, ensuring that opportunities are maximized.
Negotiation Strategy
We bolster your negotiations with insurance companies and payors by evaluating your strengths, the quality of value-based care, non-competitive services, and practice profitability.
Negotiating Managed Care Contracts
Once a plan is agreed upon, we initiate negotiations or renegotiations of agreements with payors. This includes requisitioning new contracts, escalating issues when denials occur, and presenting alternative proposals. We ensure you are informed at each step of the negotiation process and seek your input and signature on new contract terms once the payor approves them. Our focus on revenue cycle management ensures that these contracts support all aspects of your practice, and we employ all resources, including our law firm, to escalate denied and underpaid claims.
Growing Your Practice
Reveloop comprehends the pivotal role of competitive rates and favorable terms in propelling revenue growth for behavioral healthcare providers. By structuring your payor contracts to offer better rates and expedite reimbursement for your services, we empower independent providers to expand their operations. This enables them to tap into new markets, offer specialized services, and attract a larger patient base, laying the groundwork for long-term success and sustainable growth.
