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Managed Care Contract Review
With the prevalence of managed care contracting, the ability of a hospital to monitor and track compliance with the contract is becoming more and more difficult. This area of review must be handled very tactfully so as not to undermine any relationships between organizations. If one candidly looks at the operation of this arrangement you see that a contract negotiated at the higher levels of the organization is operated and monitored at the lower levels. Without the use of sophisticated software packages, anticipated and actual revenues seldom match. We review all contracts for compliance and prepare a report for management along with suggestions and necessary changes.
Benchmark : If a hospital has multiple managed care contracts, no computerized tracking of expected and actual payments, or these contracts make up more than 10% of revenues, there is a need to review compliance thereto.