Contract/Claims Management Process Improvement

Hospitals today are working in an environment of declining revenues and profits. There are continuous pressures and demands for better financial results, improved productivity and tighter management controls. Executives face numerous hurdles and roadblocks. Financial resources limit the number of employees, salaries, benefits and capital expenditures, which many times results in significant management and staff turnover and the ability to attract talent. The complexity of managed care contracts adds further pressure. The market is simultaneously demanding more and better services.

The only solution is having more dollars and everyone is looking for more money. However, most hospitals don’t have the time to turn over every stone and in some cases, don’t know where to turn for help. These additional dollars are in every hospital’s patient accounting system and are just waiting to be recovered – Hospitals are potentially losing millions of dollars every year.

Kreg, using the combination of its powerful Contract Management Analysis (CMA) software and its team of highly experienced hospital contract management professionals, can identify and assist in the recovery of revenue and help implement operational improvements along the way. On a monthly basis our teams go into hospitals with the CMA software, find dollars and recommend improvements.

This unique service includes updating and monitoring all of the clients managed care contracts for them. In addition, we assist our clients with modeling and negotiating new contracts that are presented to the hospital. The return on investment that results from more favorable contracts is often greater than the ROI from underpayment recoveries.

“We knew we were being underpaid, but we had no way of tracking and identifying the underpayments. We also wanted to simulate managed care contracts because we didn’t have bargaining power when it came to analyzing/negotiating proposals. We are a small hospital and there wasn’t room in the budget to have a dedicated FTE. ”

- VP Finance, Virginia Hospital