Part 2 of Beyond the Rates: The Contract Terms That Shape Reimbursement Carrie Knowles-Atkinson, Principal Your Health System Receives Claim Payments Every Week, But Not This Week. What Happened to Your Money? Consider a health system that receives an average of $2 million per week in claim payments from a payer. The payer identifies an alleged $6 million overpayment and begins offsetting claims, withholding payment on unrelated, otherwise payable claims. If the contract perm

BDC Advisors helps health systems evaluate existing contract language, identify risks, and translate findings into negotiation strategies. We lead managed care contract negotiations, work alongside internal teams, or advise behind the scenes, from initial assessment through agreement completion.

Why looking at financial contribution alone can conceal a major reimbursement opportunity

Alexandra Criscione, Director If a payer steers patients away from your health system, what is your discount buying? The payer wants the discretion to designate your health system as out-of-network while retaining your in-network discount. You receive discounted reimbursement while patients receive financial incentives to go elsewhere. Before you sign, ask the direct question: What are you receiving in exchange for the discount? That question gets to a bargain that has

Robert A. Dickinson, Managing Director, BDC Advisors Intractable healthcare trends, often undetected or ignored by healthcare executives, will eventually become structural problems for healthcare enterprises if not addressed intentionally: Structural margin pressure Practice of medicine in crisis Decentralized care models Ecosystem coopetition Each of these trends requires a reevaluation of strategic priorities, reallocation of people and capital resources, and likely, restru