Services
Payer contracting and development work, built on published rate data.
Andy leads every engagement. Some cover a single negotiation or model; others continue across a full payer mix.
01
Payer contract negotiation
Is this offer in line with what the payer pays others, and what should we ask for?
We start with your current contract and the payer’s proposal, then look at what that payer has published for comparable hospitals or surgery centers in your market. We model the revenue effect on your own volumes, help you prepare the counterproposal, and work through the negotiation.
The work can include
- The proposal compared against the same payer’s rates for your peers
- Revenue impact on your service mix and volumes
- Counterproposal priorities and support through the negotiation
02
Rate benchmarking
Which of our contracts are furthest behind the market?
Underpayment often goes unnoticed until a renewal is already under way. We compare your contracted rates with published rates for peer providers on the procedures that drive your revenue. For outpatient, ASC, and professional services, we also express each rate as a percent of Medicare so your finance team can compare payers on the same basis.
The work can include
- Procedure-level comparisons by payer
- A peer group you can review and adjust
- A short list of the contracts and codes worth reopening first
03
DON / CON support
Can we show the need for this project, and that it will pay for itself?
A need application has to show demand for the project and that the project can sustain itself. We prepare the service area analysis, utilization analysis, and financial projections, with revenue assumptions built from published payer rates in your market. We work alongside your project team and counsel through the application and any follow-up questions.
The work can include
- Service area and market analysis
- Utilization assumptions and financial projections
- Support for application materials and reviewer questions
04
Development and feasibility
What has to be true about volume and rates for this project to work?
A new surgery center or service line usually depends on a few assumptions: volume, payer mix, and what each payer will pay. We build the model around those assumptions, using rates drawn from your market, so leadership, boards, and partners can see which ones the project depends on.
The work can include
- ASC and service line feasibility models
- Reimbursement assumptions sourced from published rates in your market
- Scenario analysis for volume and payer mix
- Materials for leadership, boards, and physician or health system partners
Start with the contract or project in front of you.
Tell us what you’re working on and your timeline. We’ll talk through the scope and what you’d get at the end.
For growth strategy beyond reimbursement, such as capital planning or execution support for a large initiative, Andy also advises through RAW Advising.