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Services

Consulting Services

Managed Care Strategy & Design and Execution
For both payer or provider including network development for government programs and contract negotiations - Fee For Service to Value Based Initiatives.
  • Develop pricing and contract strategy
  • Assess and/or Inventory contracts, evaluate financial performance and payer compliance
  • Negotiate contracts, implement and monitor compliance
  • Benchmark fee schedules (practices only)
  • Assist in evaluation of new technologies, product lines and strategies as they relate to contracting and a revenue strategy
  • Assess or develop Network contract strategy for market entry or expansion of government programs including Affordable Care, Medicare, Medicaid, CHIP or programs supporting Veterans Affairs
  • Provide contracting services or team to develop Medical or Behavioral Health network
  • Develop and maintain provider, payer, government or regulatory relationships
Operations Support and Improvement & Revenue Enhancement and Crisis Management Services
  • Short term interim management
  • Revenue Management including contract management and payer compliance
  • Process improvement of office/operations front and back office functions and care coordination
  • Evaluation and/or management of denials and appeals
  • Advisory services for contract implementation, work processes, managed care data management/interpretation and departmental design
  • Workflow re-engineering for maximum productivity and revenue enhancement
  • Develop fee schedule and/or evaluate charge master or reimbursement structure
  • Evaluate, negotiate and manage Vendor arrangements
Project Management and Implementation
  • Request for proposals for systems or services
  • Evaluation and/or implementation of practice management or scheduling system
  • Patient Experience Training, facilitation of a Patient Centered Culture and implementation of re-engineered processes to improve patient satisfaction
  • Integration or transition of newly created/merged organizations
Business Development & Strategic Planning and Marketing
  • Evaluate new business concepts or products, assess market opportunities, identify resources, negotiate strategic relationships, and help identify and recruit management
  • Develop and conduct Mystery Shopping program for hospitals, practices and health care organizations (evaluate access, availability, and customer service)
  • Develop and monitor strategic plan and processes which support Accountable Care Organizations (ACO's) and government programs such as Value Based Purchasing
  • Evaluate, develop and implement marketing plan and strategies
Practice Administration and Re-Engineering
  • Assess current business and revenue opportunities
  • Assist in building volume, revenue and referrals
  • Provide interim management or management oversight, and assist in evaluation and/or training of staff and health care professionals
  • Assist in recruitment of both clinical or non clinical personnel
  • Assess and/or re-engineer current billing and collection processes or credentialing
  • Evaluate, implement and/or manage the appeals/denials process
  • Provide assistance in new practice development or office set up

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