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Managed Care and Reimbursement

Our payer contracting and reimbursement experts help clients understand their payer market, current contracts, and reimbursement opportunities, and our team provides negotiation support.

Managed Care and Reimbursement

As outpatient services continue migrating to the ASC setting and payer challenges persist, healthcare providers need to optimize payer revenue by restructuring contracts that allow eligible surgery to move to lower-cost, high-quality care settings. ECG’s ASC team works with all provider types, with an emphasis on independent ASCs, hospital-ASC JVs, surgical hospitals, OBLs, and physician practices. Our experts have decades of experience with and a comprehensive understanding of complex payment systems payer contracting and reimbursement modeling, enabling us to help our clients understand their payer market, current contracts, and reimbursement opportunities.

Our Services Include:
Managed Care Strategy and Planning

  • Assess payer contracts and value and provide recommendations for rate structure and targets based on services provided and payer methodology. Develop a strategy and plan for payer contract negotiations that supports negotiations for independent and individual providers as well as health systems that seek ASC subject matter expertise to support their managed care teams.

  • Facilitate, manage, and advise on all aspect of payer contract negotiations.

  • Develop payer models to assess and negotiate contract offers from commercial payers; analyze financial impact with benchmarking. ECG’s models are proprietary and used to negotiate payer contracts on behalf of clients.

  • Evaluate the operations of the ASC business office, benchmark performance against industry KPIs, and assess opportunities to improve revenue capture from payers based on allowed amounts.

  • Develop tools to inform and educate business offices on payer reimbursement methodologies. Conduct training sessions on payer reimbursement, methodologies, and rate structure.

    • Develop an ASC charge master that is sensitive to all payer methodologies to ensure revenue capture. Assess ASC charge masters to determine losses associated with inadequate charges as it relates to payer allowed amounts and methodologies and recommend adjustments to ensure ASCs are capturing revenue due from the payer.

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