The healthcare industry has been dominated by insurance carriers (BUCAs) for decades. Doctors are subject to the contracts that either they or their associated medical groups negotiate. This has historically produced very low physician payments, after the BUCA discounts and medical group costs.
Direct payment arrangements, via an RBP self-insured approach, can produce better payments for services rendered, while keeping the doctor-patient relationship as a top priority. Doctors are free to treat their patient, without feeling as though they are being short-changed.
Many medical facilities operate based on the concept of income surplus or profit. Billed charges are the standard used to defend their financial status. And, they’re used as a basis for negotiated payments from the commercial insurance community (BUCA) for services rendered. Direct negotiations with commercial plan sponsors or their carriers produce fair, transparent and more timely payments to the facilities.
A medical facility’s relationship with Medicare is also complex and constantly evolving. Medicare has become more aggressive about facility reimbursements.
Hospitals also face challenges, primarily those related to changing consumer behavior, as one-third of consumer respondents have said they are more likely to seek care at retail-based clinics.
Under pressure from competitive threats and government mandates, many providers and insurers have come to the realization that working together may be the only way to move forward in today’s healthcare environment. From multiple products and networks to various risk arrangements and financial models, there are several issues that must be evaluated when creating a successful payment strategy. RTC assists both providers and those that issue payment. And, they strive to create strategies that improve care and achieve better results for both the providers and facilities.
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