Payor Contracting
CDW Healthcare Consulting Group possesses extensive experience contracting for Commercial products, Medicare Advantage, Medicaid and dually eligibles. CDW has built IPAs, clinically integrated networks, as well as local, regional, state wide and national provider networks.
Provider contracts routinely need to be updated. New product lines, changing regulations, changing administrative requirements, updated payment models, bundled payments, risk sharing, and value based payments all impact the contracting process. CDW provides strategic guidance on key provisions, service level agreements and compensation models for different products in different states.
Your Partners in Public Payer Reimbursement
Medicare and Medicaid Cost Reimbursement
Successfully optimizing compliant Medicare and Medicaid cost reports is challenging, especially with continuously evolving federal and state regulations. Further, incorrect data filed in the cost report can have substantial unintended consequences and threaten financial distress to providers. Being tasked with comprehending complex, multifaceted legislation and applying it for optimal reimbursement on an ongoing basis is admittedly a challenge to sustain while maintaining efficient operations.
CDW team members manage reimbursement issues for all types of health care organizations, including rural hospitals, critical access hospitals, skilled nursing facilities, home health agencies, and rural health clinics. By doing so, we have deep expertise and insight into how to efficiently prepare data for cost reports an understanding that’s difficult for organizations to obtain when only performing these tasks annually with limited resources.
CDW Health Group Professionals
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Prepare cost reports for submission to Medicare Administrative Contractors (MACs).
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Act as a liaison with MACs and state agencies to help resolve cost report issues.
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Support you with Medicare and Medicaid audits, including preemptive services such as pre-audits and consultations.
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Develop strategies for the successful arbitration of appeals and re-openings of issues related to finalized cost reports.
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Prepare Medicare position papers related to appeals filed with the Provider Reimbursement Review Board.
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Assist with Office of Inspector General and MAC investigations regarding Medicare services.
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Formulate third-party reserves for financial reporting purposes.
Expert Credentialing Services
Support hospitals with federally qualified health clinic and rural health clinic billing and reimbursement issues-based credentialing associates will take your organization through the entire credentialing process. We help providers every year and would love to take the burden of payor enrollment and credentialing off your plate. Whether you’re a new/startup medical or dental practitioner, an experienced multi-specialty group, or a solo practitioner, the CDW credentialing services are designed to accommodate every organization.