About Lori
Experience
Lori is a seasoned Contracting Executive with 15+ years of experience negotiating custom fee-for-service agreements and complex value-based agreements. Her extensive contracting experience crosses all lines of business with the majority in Commercial, Medicare, and Medicaid insurance. She’s held leadership positions in provider network contracting and management for CareOregon, a nonprofit managed care healthcare company where she led a contracting team that negotiated provider contracts and ensured access to quality care for Medicaid and Medicare Advantage members throughout Oregon; and Humana, a national Fortune 500 company, where she led contract negotiations with integrated healthcare delivery systems for Humana’s Medicare Advantage plans in Oregon, Washington, and Florida. Her experience includes contracting with large health systems, multi-specialty groups, independent primary care groups, freestanding hospitals and clinics, diagnostic centers, ambulatory surgery centers, independent laboratories, urgent care clinics, and independent specialists of all types.
My Value-Add Approach
My contracting strategy will focus on your needs and your strengths. It’s important to know where you stand in the market so that you know what leverage you have going into contract negotiations. You should understand what portions of your revenue come from which payers and which lines of business (Commercial, Medicare and Medicaid). This will dictate which contracts I should focus my efforts on, just as how your largest service categories will point me to what rates are most important in the contracts I negotiate. If you have not done analysis on your needs and strengths, I will do it for you.
I will summarize your current contracts allowing you to quickly review the key terms of your contracts with all contracted payers, and since negotiations often focus on reimbursement rates first and then language, I will create two different matrices, one for each.
I will identify discrepancies between different payers and note which payers are reimbursing you at lower rates and which payers have the most cumbersome language. Understanding those discrepancies, I will set goals for how to align contracts across payers, which will greatly reduce your administrative burden and provide further leverage when negotiating.
Negotiating a contract renewal with changes in rates and language takes time so I will negotiate early. The back and forth of proposals and counters with payers can take months, as most insurance companies need a few weeks to model your proposals and craft their counters. I will create your proposal and evaluate theirs, ensuring their proposed rates are based on all the procedures you performed over a recent twelve months’ worth of data, as that will ensure to capture your practice’s activity. I will project the percentage change in revenue associated with a proposal, not only an average of the change in reimbursement for all the CPT codes utilized, but also a ‘weighted average’ based on the volumes performed for each procedure.
The best performing practices will renegotiate all their contracts with significant revenue on a yearly basis. As I renegotiate your contracts often, the better your reimbursement rates will be, and the quicker each negotiation round will be. This is due to the changes CMS makes to the fee schedules it publishes every year, which I stay on top of and proactively scrutinize. A vast majority of payer contracts rely on CMS fee schedules (RBRVS, ASC, ASP, etc.) which get updated yearly or quarterly. A lot of contracts will have language stipulating that reimbursement rates are tied to the most recent release of the CMS fee schedules, and therefore these CMS updates will affect your reimbursements regardless of whether you renew or amend your contracts. For that reason, it’s to your advantage that I proactively scrutinize new releases of relevant fee schedules.
My service includes a comprehensive consultation to help identify negotiation opportunities for reimbursement increases and language changes that reduce your financial and operational risk, and a comprehensive report that includes a project plan with milestones and timelines to completion.
Let me help you get the most
out of your payer contracts.
Book a Free Consultation Today!