Transplant Management Group, LLC (TMG) was founded with the express purpose of providing state-of-the-art educational, training, and consulting services to Transplant Centers. TMG provides one of the most comprehensive package of services that is integral in transplant business development today.

Managed-Care, Commercial Contract, and Payment Review

Transplant programs can have a portfolio of managed-care and commercial contracts that assure patient volume. However, unless the business and financial infrastructure is in place to operationalize these contracts, the potential to not capture all the revenue that is contractually allowable is significant.

A Managed-Care, Commercial Contract, and Payment Review will typically include, but is not limited to the following:

• Review and Evaluate Administrative Requirements
  
• Review the Medical Review Process including Denial/Appeal Structure
  
• Review Authorization/Notification Requirements
  
• Review Global Adjudication Language
  
• Review Selected "Global and Facility" Accounts for Payment Accuracy
  
• Review "Carve-Out" Requirements
  
• Review Reimbursement Structure Against Local/National Reimbursement
  
• Review Prompt Pay Time Frames and Penalties
  
• Review Adjudication Documentation
  

Click on the drop down menu below, then click "Go" to learn more about our services.