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SOLUTIONS | Managed Care Contracting

Build the foundation for solid financial results and profitable growth. 

The right managed care contracts can set your surgical organization up for success. nimble advisors partner with your team to dig deep into your existing contracts and business, evaluate market opportunities, and pave a path toward real financial improvement.

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Why surgical organizations trust nimble with their managed care contracts:

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Specialized experience

Responsible for managing and negotiating 1,000s of payer contracts annually. 

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Broad coverage

Access to reimbursement benchmarks and insights across 45+ states.

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Deep relationships

Experience working with payers nationwide.

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Unique perspective

Evaluate and negotiate contracts through the lens of an RCM expert.

Ensure maximum reimbursement for every procedure.

nimble has vast experience working with major payers to turn contract management and analyses into real growth opportunities for your surgical organization. While engagements can be bespoke, we’ll always cover:

Contract Management

  • Incorporate metrics into SOPs for billing team to ensure accuracy
  • Communicate payer updates, requirements, and notices to stay compliant
  • Measure contracts against payer and regional benchmarks

Chargemaster Analysis

  • Detailed reimbursement matrix by payer for thorough chargemaster evaluation
  • Ensure maximum reimbursement down to the CPT-code level
  • Assess compliance by assuring no incidental overcharging

Case Analysis & Costing

  • Measure full case reimbursement against other contracts and Medicare
  • Determine profitability of each case based on payer contract and overhead costs
  • Review practice trends to ensure maximum case-by-case profitability

“In our very first year with nimble, with the same number of cases, we have increased our cash per case to $1,400, representing an increase of approximately $600 per case, or 73%, all of which is pure profit for us.”

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OWNER AND CEO, SURGERY CENTER

“Due to nimble expertise and experience, they were able to renegotiate better contracts and increase our contract reimbursement by 305%. We’re now able to bring additional cases to our center.”

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ASC ADMINISTRATOR

“Since partnering with nimble, our cash per case has increased 34%.  I know revenue cycle can be challenging; nimble does it so well.”

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ASC ADMINISTRATOR

nimble RCM solutions can maximize your ROI.

nimble experts can help answer tough questions that identify areas for your financial improvement

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