Creative Managed Care Solutions Blog

The members of your health care facility are working together to improve and save lives. You share in a mission to improve the community--and that is honorable. It is also important to remember that your hospital or clinic is a business. Third-party payers, like managed care organizations, may forge contracts with your hospital to help cover service costs. In these instances, it is important to stay on top of your contracts--and be prepared to take action to preserve a mutually beneficial business relationship. Hospital contract negotiations are a vital component of your business. They can redefine expectations with your payers, ensuring you are being reimbursed fairly and can focus on delivering the best possible care to your patients. They allow your business to grow and adapt to the changes in your industry--while keeping all parties accountable to their responsibilities. When negotiating new terms of your hospital contract with MCOs, it is important to choose a profess...

Today’s health care environment is more expansive than ever. Thanks to advances in technology and treatment methods, the medical field can assist patients in many different ways. However, with expansion comes complexity. Third-party payers, also known as managed care organizations, have taken the place of patients in footing the bill for your services. While you may have an agreeable relationship with your managed care organization, there may be caveats in your contract that are preventing you from optimizing the sustainability of your hospital or clinic. Let’s go over the benefits of a hospital contract review . Managed care organizations (MCOs) and establishments that render medical services are connected by a managed care contract. It is essentially a business agreement that defines the services that care providers are expected to render, and what the MCO will pay or do to uphold the agreement. Since MCOs are responsible for much of the terms and conditions that guide th...