Our managed care contract has always included a fee for service component and a capitation component depending on the plan. These two components compliment each other and what we loose in one, we gain in the other.

Our organization uses multiple contracting arrangements, most are per diem (set amount per day) although a few are POC(% of charge) which is what we prefer. Occasionally we will negotiate carve outs which is necessary if we are admitting a high cost managed patient, for example a patient who will require factor XIII.

Another extremely important factor in managing REV is linked to our concurrent case management/ UR program where we employ RN Case Managers who conduct all pre-auth and continued stay reveiws to maximize our reimbursement. Since many of our per diem contracts are tiered by the type of care, i.e. Vent/ Tele, Rehab (TBI/ SCI) we aggressively negotiate ongoingly to ensure we are being reimbursed appropriate to the service. We have maintained a 0 concurrent/ retro denial rate through this program for the last 2 years.