Payor Contracting
Effective Strategies & Education
“SMSC was a tremendous help with our payor contracting and negotiation process. They performed a comprehensive contract review of our primary commercial payor contracts and provided a detailed analysis that identified both immediate and longer-term opportunities for revenue enhancement. They shared specific points to use in negotiations that I was able to use successfully in contract renewal discussions with payors.”
Jim Hueber, Colorado Imaging Associates
SMSC provides a suite of services that helps organizations create effective payor strategies, develop more favorable reimbursement rates and contract terms, and enhance their ability to maximize traditional and non-traditional payment arrangements. Examples of our success include:
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Experienced Staff
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Demonstrated expertise in negotiating higher-than-standard rates with commercial payors to yield additional revenue.
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Flexible Service
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Contracting using a variety of reimbursement methodologies from fee-for-service to bundles to case rates.
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Extensive Network
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Developing relationships with outside providers or other organizations to effectively partner in alternative payment models and risk-based arrangements.
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On-Going Support
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Creating effective, ongoing education for providers and business staff.
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Customized Programs
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Building unique programs with TPAs and self-funded employer groups to increase direct referral sources.
Key Services
Evaluate contract language to identify problematic policies and terms for contracts in place.
Identify opportunities for financial increases through claims analysis and reporting.
Create strategies for promoting specific service lines or procedures with carriers or purchasers.
Conduct a market review and identify opportunities to capitalize on unique offerings.
Develop outreach approaches for fostering stronger relationships with carriers and provider networks.
Develop a payor contracting strategy to align with desired objectives.
Create a plan for maximizing reimbursement opportunities, including alternate payment methodologies such as carve-outs/case rates, risk-based, or purchaser-direct.
Assess readiness for bundled payments, including potential opportunities for partnering with other local providers.
Provide insight into potential operational impacts of risk-based or bundled arrangements.
Deliver ongoing coaching & education to providers and other staff regarding the benefits, implications, and risk mitigation for non-FFS payment model.
Provide coaching on approaches for payor negotiation success.
