An Elevated Approach to
Payer Contracting
Navigating the rural healthcare landscape demands understanding payer contracts and optimizing them for sustained growth. Stroudwater Associates curates a meticulous approach to payer contracting tailored to the unique nuances of rural healthcare providers. Whether initiating contract sourcing or mastering strategic negotiations, Stroudwater arms rural hospitals with the expertise to realize financial and operational growth.
Wayne County Hospital: Swing Bed Improvement in Risk-Adjusted Mobility
Wayne County Hospital (WCH), a Critical Access Hospital (CAH) in southcentral Kentucky, participated in a yearlong Swing Bed Quality Improvement project sponsored by the Kentucky State Office of Rural Health and the Flex Program. WCH staff needed to improve their Risk-Adjusted Mobility Performance scores for their swing bed patients, and WCH’s rehabilitation and nursing staff needed to work as a team in motivating their swing bed patients to achieve their mobility goals, heal, and return home.
Read Case StudyThe Stroudwater Service Spectrum
Level 1: Contract Discovery
Success starts with a comprehensive groundwork. Stroudwater’s experienced rural healthcare consultants are there to guide rural hospitals to ensure they have:
- A complete contract assembly, including appendices, attachments, and critical exhibits.
- Exhaustive companion documents, leaving no stone unturned.
To embark on this level, client data required includes Tax ID, specific provider numbers linked to the contracts, and essential payer contact details.
Level 2: In-Depth Contract Scrutiny
Healthcare contracts are known for their intricate details. We illuminate the path with:
- A keen focus on commercial FFS payer contracts, sidelining VBCs for precision.
- An exhaustive analysis of contractual terms, with a lens on client-centric provisions and obligations.
- Distilling best practices, flagging potential pitfalls, and outlining imperative client duties.
- Collaborating with pivotal stakeholders like CFOs and specialists to fine-tune contract strategies.
- A lucid breakdown of reimbursement models, ensuring clarity in financial commitments.
To execute this level with precision, we seek contracts, key appendices, stakeholder contacts for engagement, and other essentials.
Level 3: Financial Diagnostic & Contract Assessment
Beyond text, it’s numbers that matter. Our team dives deep by:
- Benchmarking the rural hospital’s top CPT codes, both by revenue and volume, against Medicare standards.
- Scrutinizing top DRGs with a focus on volume aligned with Medicare reimbursement rates.
- Unraveling remittances, juxtaposing past charges with current contracted reimbursement benchmarks.
- Foreseeing the common culprits: top claim denial reasons, empowering clients for strategic negotiations ahead.
For this analytical dive, essential documents include past-year revenue reports, and detailed remittance documents, among others. Paper-based data may require scope recalibrations.
Level 4: Full-Spectrum Contracting Support
For institutions desiring holistic support, Stroudwater emerges as the trusted ally by:
- Engaging through the intricate phases of the contracting lifecycle, spotlighting negotiations.
- Embracing challenges of value-based contracts, recognizing their distinctive requirements.
This level leverages all prior data.
The Payer & Provider Contracting Team
Stroudwater Associates: Guiding Light in Payor Contracting
The terrain of healthcare contracts is riddled with complexities. It’s not just about expertise; it’s about forging a partnership steeped in insight, foresight, and transformative action. Stroudwater Associates, with its legacy of excellence, promises to steer your contracts toward a promising, revenue-optimized horizon.
