Healthcare Corporates

Regulatory and Payment Expertise for Strategic Planning

Healthcare corporate clients hire us for specific diligences, or on annual retainers for ongoing access to our regulatory team, customized for their particular situation. Retainer clients typically receive annual or semiannual reports on regulatory and legislative reimbursement prospects for their sectors, and/or for complementary sectors. Known as the RAP™ Review, the reports provide in-depth explorations of likely legislative actions, proposed rules, Centers for Medicare and Medicaid Services (CMS) code updates, and payment reforms.

Farragut also delivers macro-political overviews and outlooks where our Political Strategist presents key trends in healthcare, and focused attention to each client’s marketplace. These meetings or conference calls, which can be combined with written reports, serve to review potential legislation and rulemaking provisions that are invaluable to near- and long-term planning strategies.

In addition to these ongoing policy deliverables, our corporate clients have regular access to our diligence team for deep dives into specific issues, or for clarification and guidance through a particular law or regulation, helping them cut through the media or lobbyist noise and identify impactful insights for action.

Regardless if our clients have an in-house regulatory team, they have access to Farragut’s coverage of Congressional hearings and Medicare Payment Advisory Commission meetings, GAO/OIG reports, and a variety of Washington Beltway policy events. We work with the regulatory team or the C-suite decision makers to ensure that reimbursement related movements and trends in specific sectors are recognized and understood.

Our Medical Audit and Compliance division works with corporates to conduct billing and coding audits and compliance program reviews throughout physician practices and specialty healthcare services.  Our medical reviews focus on identifying and correcting problem areas before commercial or government payers challenge inappropriate coding or documentation that could trigger a potentially costly and time-consuming third-party payer audit.

Sample list of key concerns:

Survey and analysis of commercial payers for toxicology laboratories
  • Outlook for reimbursement and rates in target markets.
  • Proposed coding changes by CMS.
  • Review of utilization management and prior authorization policies.
  • Oversight and concerns by CMS and OIG (Office of Inspector General).
Overview and outlook for contract therapy payment reimbursement in SNFs
  • Medicare benefits, payment basics and reimbursement trends for SNFs.
  • Acumen study: SNF therapy payment models.
  • Bundled payment for care improvement (BPCI) initiative.
  • Outpatient therapy reimbursement and coding analysis.
Review and analysis of Medicare payments and commercial payer survey for durable medical equipment (DME) orthotics
  • Orthotics Medicare Part B DME payment rates overview.
  • Prospects for inclusion of orthotics in competitive bidding.
  • DME Medicare Administrative Contractors (MAC) activity and new prior authorization rules.
  • Analysis of additional trends and patterns impacting commercial reimbursement.
Managed Care Contract Review and Analysis
  • Contract provisions that impact rates (i.e., escalators, etc.)
  • Analysis of re-negotiation language, including the risks and rewards of keeping current language or making amendments
  • Analysis of whether payers are operating a wrap network for out-of-network solutions
  • Identification of Silent PPO issues
Post- and pre-acquisition payer strategy
  • Advice on payer relation strategy
  • Assessment of trends and coverage utilization in states targeted for new acquisitions
  • Identification of coverage revisions by local payers and influencing factors
  • Analysis of payer authorization policies and geographic coverage variations
  • Analysis of in- vs out-of-network dynamics/pressures
  • Identification of a floor to cuts for a certain code/specialty