What You Need To Know About Managed Care Experts

Hospitals and healthcare providers provide a key service to patients. But too often, they run into difficulties making sure they get paid for the vital care they provide. To ensure they are getting paid for their services and also to negotiate better contracts, many are turning to managed care consultants for help.

Better Contracts 

Hospitals are seeking managed care consulting firms such as Executive Level Managed Care Expertise to help them get the most out of their managed care contracts. By negotiating better contracts, such experienced managed care consultants act as a bridge between hospitals and insurance companies to ultimately support better patient care. 

That can be especially helpful in such turbulent times with so many changes in health care payer models.

Denied Claims

Earlier this year, hospital officials in Illinois were not being paid under the Medicaid managed care program touted by then-governor Bruce Rauner to be a win-win for everybody, helping the state save money while patients receive better care. 

The Illinois Association of Medicaid Health Plans said about a quarter of hospital claims to the Medicaid managed care companies are being denied. 

Managed care consulting firms can help with such issues. 

Services Affected

Sinai Health System is one hospital that has hired consultants to make sure that it gets paid. Amita Health is another that has also hired expert help to address the issue. 

“When you’re not being paid for the services you’re providing, it has an impact on the level of service you can provide, the number of staff you can employ,” said Mark Frey, president and CEO of Amita. 

Other hospital leaders agree such delays can affect services and staff. 

“We’re going to have to reduce services, reduce staff and reduce our expenses when they don’t pay us,” said George Miller Jr., president and CEO of Loretto Hospital, which primarily services Medicaid patients. 

Turning to expert help in such times of confusion can help your hospital avoid having to reduce staff and cut services. Hiring managed care consultants free up hospitals so they can focus on their mission: patient care.