Is your network getting the reimbursement it deserves?

Physician networks, whether they are an IPA, PHO, Multi-Specialty Clinic,
Hospital Employed Physician group, or other model, are unique for several
reasons. Their size as well as their varying degrees of integration can
translate into significant reimbursement advantages.

We work with many physician networks to help them fully understand their
reimbursement profile. The unique market dynamics that exist around
these networks means that many areas of poor reimbursement can become
buried within the organization. Our analysis reviews all care centers and
compares those results to the results internally between carriers as well
as to the results in the rest of the marketplace. The result is a center and
specialty specific analysis that highlights potential reimbursement gains.

If the report shows you are losing money, you may want to negotiate new
rates with your carriers. Only you can decide if a new contract is the
appropriate next step; but if that is what you decide, then our analysis will
arm you with the information needed to build your business case. With this
information you will not only know how your network is performing, you will
also know which areas are being disadvantaged, which carriers to address and
which codes are out of line.

The information you receive:

Each project is unique but reimbursement analysis begins at the code
level for each carrier and specialty. Throughout the reports this information
is shown at various degrees of detail but code level reimbursement is
always provided as well as several different aggregations of the data.
Some of the reports provided include:

Overall Performance Synopsis
Within System Carrier Performance
Specialty Performance Synopsis with Loss Totals
Specialty Performance Detail
Carrier Disparity Report with Code List and Loss Totals
Medicare Disparity Report
Historical Reimbursement Performance Trend

All information is compared to benchmarks for reimbursement
performance in your area and specialties.

Need help negotiating?

If you need help negotiating, it is typically wise to start with relationships that already exist with your practice, such as a CPA, lawyer or practice consultant. However, if you do not have those relationships, or if those people are not experienced in the area of reimbursement, we can help.

The Center for Healthcare Reimbursement works with Dean, Dorton &
Ford, and Louis T. Roth,who offer reimbursement negotiation services for medical practices.

These companies fully understand the intricacies of reimbursement and
work to ensure their clients are reimbursed appropriately. Regardless of
whom you work with, the Center for Healthcare Reimbursement provides
the comprehensive reimbursement analysis needed to fully understand
your practice standing.