Experts in Payer Strategies for Clinical Laboratories
Burns Consulting Group specializes in assisting clinical labs with payer strategies and provides a full suite of managed care advisory and consulting services.
Partnering with medical labs, managed care companies, health systems, and providers, they offer subject matter expertise and insights into in-network credentialing and contracting, strategic planning, managed care contracting, revenue cycle, and value-based care contracting.
Why Burns Consulting?
Founded by seasoned and experienced health care executives with a combined 40 years in the industry, Burns Consulting Group offers a wide range of managed care consulting services. Whether it is developing go-to-market strategies, advising clients on the current state of the managed care industry, or negotiating payer contracts at favorable pricing, we work in a collaborative and professional manner.
Burns Consulting Group has a history of delivering results that can be counted on.
A provider term that generally represents the process of a provider applying to health insurance companies/payers for participation in their networks. Payer network types include HMO, PPO, POS, EPO, Medicare Advantage, Medicaid, and rental networks, to name a few.
A payer term that generally represents the internal process of reviewing a provider’s credentials against national, standardized protocols and standards, such as those presented by NCQA and URAC. Payers utilize credentialing committees that meet with varying frequencies and are the critical dependency to contracting.
This step occurs following successful credentialing. Once a provider is credentialed, a standard network contract is offered to the provider. Typical reimbursement rates are based upon a fee schedule as a percentage of Medicare.
What is Medicare Advantage?
Medicare Advantage is a Medicare health insurance plan offered by a private-sector health insurance company. Medicare Advantage health insurance companies offer HMO and PPO products and networks.