Welcome to Solutions Healthcare Management - People. Technology. Solutions.

Reimbursement levels and contracting strategies directly impact physician compensation and practice growth. Identification of acceptable levels of fee for service discounts, capitation rates and conditions of participation in a network is part of the analysis we can provide. In addition, reviewing payer contracts for language, fee schedule, and other restrictions, is extremely important to ensure maximum reimbursement in an area that often represents declining receivables.

We use market-specific data tools to provide benchmark comparisons.

Services include:

Fee Schedule Analysis
- Evaluation compared to regional benchmarks
- Recommendations of acceptable reimbursement levels

Contract Review
- Physicians credentialed with the plan
- Plan products in which physicians are credentialed
- Covered lives in each plan product
- Direct contract credentialing vs. PHO or other entity
- Product fee comparison of top 40 practice CPT codes

Credentialing
- Review processes
- Process improvement
- On-line credentialing

Payor Mix Analysis
- Fee schedule compared to practice fees
- Medicare fees
- Major commercial fees

EOB Audit
- Payment compared to contract rates
- Comparison of bundled and unbundled charges
- Denials processes
- Balance billing and collection from non-contract payors

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