Reimbursement Pathways provides reimbursement consulting services to healthcare providers (health systems and physicians) in the areas of payer contract evaluation, management, performance, and negotiations based on the following 4-step process:
1. Value Story
We help you define your “value” in the market, your “value story”. If one already exists, we will evaluate the data you have available and propose recommendations for improvement. If one does not exist, we will create one for you.
2. Payer Portfolio Analysis
We prepare a payer portfolio analysis. This is a benchmarking analysis of your top 3-5 (or all) commercial payers’ payment rates to Medicare, or another viable source. This analysis highlights opportunities to improve payment levels and inform the development of payer specific proposals for rate increases.
3. Negotiation Strategy
We then develop and execute a negotiation strategy based on proven negotiation principles. We turn the tables and secure the payment levels that you deserve.
4. Audit of Payer Contract Management Activities
We perform an audit of your payer contract management activities through the contract lifecycle using industry best practice methodologies and approaches. Areas of focus include contract analytics, claim audits, denials and contract management (i.e. operational processes), contract language, fee schedules or rate structures, value programs, etc.
Through this approach, our team helps you achieve your greatest financial success from your most important asset: payer contracts.
Send us a message to learn more
Reimbursement Pathways is committed to helping you achieve your greatest financial success. Please contact us if you have any questions or would like to schedule an onsite visit.