Contracting & Pricing
For your practice to be sustainable, you must be able to negotiate payer contracts that reflect the true value of your tangible and intangible services. Even hospitals and clinics that are efficiently run and with minimal overhead could see their financial well-being compromised if contracts with insurance companies are not reviewed, negotiated and drafted properly.
Oftentimes, a provider also has to deal with multiple insurance companies, each with its own unique set of rules and payment structures. Outsourcing payer contracting, rather than handling it in-house, gives your organisation the leverage to correct unfavourable contract provisions and grow your practice further.
ACCUMED has a team of professional consultants with vast healthcare insurance experience, who can advise you on the proper pricing model for your respective payer contracts. We do not believe in a one-size-fits-all approach to payer contract negotiation as every provider has its own strengths and market positioning strategy. As a result, our Contracting and Pricing Services are customised to suit your practice’s specific needs.
We start by profiling your facility, analysing your historical claims and then creating a SWOT (strengths, weaknesses, opportunities and threats) report to help gauge your practice’s financial prospects. In creating a pricing guide, we employ a scientific costing methodology – RVUs (Relative Value Units) – which calculates the payment based on the relative time, skill and intensity required to provide medical service to your patients; as well as the relative expenses such as staff costs, office space and equipment needed to maintain a practice.
Working very closely with you as our partner, we aim to ensure fair pricing of your contract so you can then maximise your revenue potential and achieve a sustainable market positioning. We also ensure that your contract terms related to submissions, re-submissions, denial management and reconciliation are impartial to both you and the payer.