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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, it has become essential for healthcare providers to optimize payer revenue through the restructuring of 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 payer contracting and reimbursement modeling and a comprehensive understanding of complex payment systems, enabling us to help our clients understand their payer market, current contracts, and reimbursement opportunities.

Our Services Include:
Managed Care Strategy & Planning

  • Assess payer contracts, determine 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.

Facilitate, manage, and advise on payer contract negotiations.

Using proprietary payer models, assess and negotiate contract offers from commercial payers and analyze the financial impact through benchmarking.

Evaluate the operations of ASC business offices, 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 ASC chargemasters that are sensitive to all-payer methodologies to ensure revenue capture.
  • Assess ASC chargemasters to determine losses associated with inadequate charges, and recommend adjustments to ensure ASCs are capturing revenue due from payers.

Managed Care and Reimbursement

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Related Services

  • Payer Contracting & ReimbursementDISCOVER
  • Performance TransformationDISCOVER
  • Financial Advisory ServicesDISCOVER
  • Mergers, Acquisitions, & PartnershipsDISCOVER
  • Facility & Capital Asset PlanningDISCOVER
  • Ambulatory & Service Line Performance ImprovementDISCOVER
Managed Care and Reimbursement

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