Contracted reimbursement strategy development program

CONTRACTED REIMBURSEMENT STRATEGY Mercury Advisory Group

Step 01 Market Analysis Contract Language Review Payer Report Card Analysis Business Analysis

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Ideation / Elicitation Historic Relationship

Measurement & Evaluation of Relationship Sustainability

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Step 0

Brand Assessment Unique Strengths and Capabilities Rival Analysis / Niche Opportunities

Report Interim Findings

Negotiate any required amendments; Implement fallback or dealbreaker plan- if necessary

Executive Interviews Goals & Objectives

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Create Action Plan Implement Strategy

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Revenue Cycle Fact-finding and Team Interviews

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Payer & Internal Stakeholder Interviews (Problems / Preferred Solutions) Present Final Recommended Strategy Set Measureable Objectives Obtain Final Approval

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Connect Silos

www.mercuryadvisorygroup.com

800.727.4160

At Mercury Advisory Group our experts have helped healthcare providers around the world to develop a unique contracted reimbursement strategy by breaking the planning and execution process into six distinct steps that every healthcare provider must take regardless of the type of services they offer: 1.

2.

3.

4.

Ideation / Elicitation / Situation Analysis / Historic Relationship •

Perform Brand Assessment

•

Identify Unique Strengths and Capabilities

•

Perform Rival Analysis and Identify Niche Opportunities

•

Elaborate a Proposed Strategy Anchored to the Realities of Implementation

Market Analysis and Research •

Contract Language & Rate Review

•

Internal Business Analysis (What’s selling, to whom, costs, margins, etc.)

•

Competitor Analysis (Who else has market share, how much, and why, etc.)

•

Consumer Loyalty Assessment (Key Employer & Referral Relationships, etc.)

Compile Interim Findings from External Review •

Offer Recommendations

•

Receive Feedback

Internal Fact-Finding •

Revenue Cycle Team

o o o

5.

6.

Refund Processors Denials & Appeals Team Pre-Auth / Pre-Cert

•

Medical Records

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OR Scheduling

•

CDM Compliance / Pricing

•

Purchasing & Central Supply

•

Pharmacy

•

New Technology Planning Committee

•

Marketing, PR & Business Development

•

C-Suite and Board of Directors

•

Managed Care Analysts and Negotiators

Present Final Draft of Recommended Strategy and Proposed Business Rules •

Set Measurable Objectives

•

Obtain Final Approval

•

Create Action Plan

•

Begin Implementation

Negotiate New and Amended Terms; New Contracts •

Implement Fallback Plan or Deal-breaker Protocol, if necessary

•

Periodic Measurement and Evaluation of Relationship Sustainability

Practice Leader

In 1991, Maria Todd left a large national HMO Provider Relations role to work as an IPA Executive Director in Colorado. For nearly 20 years, she has been a internationally recognized authority on managed care program development and administration. Her experience is extensive in the design, organization, and administration of healthcare provider networks throughout the USA and abroad. Ms. Todd brings the diversity of a clinical, administrative, paralegal and former HMO Provider contracting background to the organizational and negotiation table. As President and CEO of Mercury Advisory Group, a Denver-based international healthcare consulting firm, she provides consulting services to doctors, hospitals, governments, investors and other healthcare providers. She manages a team of healthcare experts which develops clinical and administrative guidelines for physicians, emerging integrated practice groups and hospitals. She serves as developmental consultant to several new and established integrated health delivery systems throughout the USA, and has consulted to the United States Military, the Veteran’s Administration, and Cleveland Clinic, among many others.

She has reviewed more than 5000 contracts in the USA and abroad for hospitals, medical groups, lab, ASCs, imaging, and DME providers/suppliers.

In 2010, the US Patent and Trademark Office (USPTO) granted Maria Todd the registration of a new term of art, the Globally Integrated Health Delivery System® for her application of the integrated health system concept and operations to the medical tourism and health travel arena. She built the first and only globally integrated health delivery system which combined all the elements of ACO accountability, predictive modeling, case management, provider credentialing and privileging, quality, safety, clinical outcomes and patient satisfaction metrics, telehealth and telemedicine technology applications, electronic medical records, international cloud-based data and privacy security, and TPA operations for provider claims settlement and bill audit. To this, she added a fully-documented system to manage complex and specialized health travel logistics coordination to the mix.

Ms. Todd lectures nationally and has personally conducted over 2700 seminars, webinars and educational programs on managed care and integrated delivery system development since 1993, with well over 60,000 attendees. She is available to address physicians and hospitals as well as state and national associations on these and other issues.

She is the author of a number of best-selling healthcare management handbooks, including,

• • • • •

The Managed Care Contracting Handbook, 2nd ed.

The Physician Employment Contract Handbook, 2nd ed.

IPA, PHO, MSO Development Strategies Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond The Handbook of Concierge Medical Practice Design

• • •

The Handbook of Medical Tourism Program Development The Medical Tourism Facilitator’s Handbook The Employers’ Guide to Medical Tourism Benefit Design

and others

The Managed Care Contracting Handbook, 2nd edition is available in our e-Store or from your favorite bookseller.

Maria Todd’s Managed Care Strategic Planning and Implementation program is highlighted in her latest edition of The Managed Care Contracting Handbook.

Contracted Reimbursement Strategic Planning The assistance she provides to healthcare providers includes a comprehensive package of services, documents and templates, designed to support you and your staff in each of the areas you need to focus your attentions to get off to a solid start. The program includes: 1.

A detailed outline to develop a Contracted Payer Report Card. Updated to reflect the changes in healthcare reform under the ACA (“ObamaCare”), it highlights hassle factors, profitability, and service failures that make contracting with certain payers more miserable than any other activity in the revenue cycle. It also identifies those payers who bring you margins and treat providers with dignity, respect and fairness.

2.

A checklist for everything you’ll need to know to conduct due diligence on a licensed health plan, PPO, Self-

3.

A complete collection of easily-edited forms, policies, office and revenue cycle procedures and correspondence

funded employer, or TPA templates to save you time and money and mitigate potentially overlooked sources of revenue and leverage more ammunition when facing unfair claim denials, refund requests, and other payer-mandated write offs.

4.

Working draft documents and sample contract language that your attorney can review for final approval

5.

A complete brand assessment and market analysis that examines what business you currently have and how to attract more lucrative relationships and leave the less lucrative and costly remainders for competitors to fight over.

6.

A silo-busting, stakeholder communication plan that eliminates costly oversights, missed opportunities, and rallies the entire team at every level, in every department to align all-hands towards better, more profitable contracts.

7.

A step-by-step business development outline and action plan that includes social media marketing, print, video, and local advertising and public relations activities to improve your ability to attract the best contracts and most favorable terms.

8.

A unique, proprietary Managed Care Contract AnalyzerTM software application that loads onto MS Word® and enables contract analysts to quickly identify vague, problematic costly or dangerous terms in contracts. It color codes more than 150 words and phrases that are “Known offenders” that cost money, time,

and aggravation.

The license fee for the application is perpetual and included with our service

package. It is not for sale without the training we provide to use the app.

Our experts guide you step-by-step to success • • • •

Feasibility Analysis and Market Research Business Decisions, Organization-wide Communications Brand Analysis and Niche Identification Revenue cycle staff competency training and Process Documentation (You’ll need it for ISO certification or NIAHO Accreditation)

•

Post-Implementation Continuous Improvement

We also offer a turnkey program that includes all of the above.

Our complete program is perfect for busy providers who need to focus on other matters and have us do all the research, fact-finding and recommend a complete strategy and implement it. Our team will become an extension of your staff, managing all the changes and supporting you every step of the way. You’ll meet with her once a week by phone or in person (in Denver) to stay in the loop and make decisions on next steps. Maria’s team handles all the heavy lifting, the paperwork, the market analysis, mystery shopping your competition, staff development, marketing, patient accounts, and negotiation training for your contract negotiators. We can also negotiate on your behalf. We work closely with your VP of Revenue Management, practice managers, your attorney, and your accountant or CFO to help you meet and exceed your stated goals.

We Make it Easier to Be in the Business of Healthcare Contracted Reimbursement Coaching Program Our Coaching Program is designed for physicians and revenue managers who want to pursue their own strategic planning and contracted reimbursement improvement independently and want an experienced adviser or sounding board. We help clients who have already begun or plan to being the planning and execution on their own and need a little additional guidance. Maria’s coaching option makes it easy for you to purchase blocks of time for phone coaching from a managed care expert to use as you need it. Blocks start at 90 minutes per month, billed quarterly. Unused time rolls over to the following period.

Related Services Available • • • • • •

Outsourced Contract Review and Recommendations Outsourced Negotiation Contracted Reimbursement Leadership Retreats and Strategic Planning Facilitation Team Coaching (On-site at your location, or at our training facility or at a Colorado Mountain Resort) Outsourced Denied Claims Appeals Denied Claims Appeals Coaching

Call us to learn more. 800.727.4160