There is nothing more important to a physician practice than its managed care contracts. For most hospital based groups, the percentage of patients that are under a fixed government payer (Medicare, Medicaid, Champus, etc.) is often forty percent or higher. If you add to this the self-pay percentage, the remaining percentage of patients may be fewer than 50%. Groups need to be assured that the remaining payers, commercial and managed care, are paying and paying at market rates.
CMPM has demonstrated its ability to negotiate fair market reimbursement on behalf of their clients. In addition to securing dramatic increases in reimbursement, CMPM has also obtained unprecedented changes in contract language for its clients. These language changes can be more important than fee schedule changes because it's in the language that managed care companies obtain their "hidden" discount. These hidden discounts can take the form of various processing edits that lead to excessive denials, bundling of procedures and shifting the economic burden back to the physician. In addition, we eliminate one-sided provisions, inappropriate pre-certification language, the inability of the group to exit a contract that is not performing, mandatory arbitration language for reimbursement based disputes and unilateral change provisions.
CMPM and its staff have negotiated over a thousand managed care contracts for our clients over that past 18 years. We have been able to successfully reach contractual arrangements with all major payers that did not compromise on language or reimbursement in every market that we serve.
In addition, CMPM has negotiated hundreds of hospital contracts for its clients. To a hospital based physician group, their professional service agreement with their hospital is the foundation in which a successful practice is built. As with managed care contracts, these contracts too can be inappropriate; not affording its provider with proper terms whether it's dealing with exclusivity, non-compete provisions, mandatory managed care participation, inappropriate level of financial support for management or part A time provided by the group. CMPM has been successful in negotiating on behalf of its clients proper hospital agreements. This resulted in proper treatment of its groups without undermining the group's relationship with its institution.
© 2008 Comprehensive Medical Practice Management, Inc. All rights reserved.
Contracting essentials 
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