Katz & Associates financial services assists health care providers by:  

  • Evaluating the financial feasibility of new services and projects based on assumptions concerning service volume, expected reimbursement, regulatory requirements, capital sources, expected operating costs and expected hurdle rate.
  • Assessing performance under risk contracts and recommending contractual and/or operating changes to improve performance.
  • Identifying contractual underpayments and denials and developing strategies to recover withheld funds. Negotiating settlements, if appropriate.
  • Preparing business plans for IPAs, physicians' practices, and new services.
  • Preparing turn around plans for distressed providers.

Katz & Associates serves as an expert witness by:  

  • Preparing financial analyses and testifying about correct coding and billing, forgone profits, estimated future medical care costs, and impact of competition on profits.
  • Evaluating, estimating costs and insurance coverage for care plans for injured and/or disabled individuals.

Katz & Associates assists investors by:  

  • Evaluating investment proposals for market and financial feasibility.
  • Developing growth strategies for portfolio companies.
  • Reviewing business plans for new ventures and portfolio companies.

Typical projects include:  

  • Assessed the financial feasibility of a hospital's financial recovery plan.
  • Assisted a distressed medical practice to recover its financial viability and affiliate with a larger medical group.
  • Negotiate managed care contracts for IPAs and PHOs and prepared medical management and business plans.
  • Assisted the secured creditors of a hospital chain in bankruptcy, evaluated the recovery plan of the debtor in possession and prepared an alternate recovery plan including financial projections for the reorganized company.
  • Assessed the business plan and prospects of a specialty hospital chain emerging from bankruptcy and recommended strategic redirection to avoid additional financial difficulties.
  • Reviewed surgery billing in an accident case, corrected coding and repriced the bill to reduce the settlement amount for an automotive insurance company.
  • Assisted the defense in an antitrust case; estimated the plaintiff's lost profits due to the antitrust violation.
  • Assisted a health care financial services company and its venture capitalist evaluate the viability of its growth strategy.
  • Assessed the viability of a retirement home company's expansion plans.  Prepared a financing plan for growth.
  • Prepared a business plan and negotiated financing for a freestanding heart center.
  • Tested the market and financial feasibility of a proposed medical care product.

 Katz and Associates Operational Services include:  

  • Review clinical operations and management processes to identify areas for improvement and assist in instituting procedural changes to increase efficiency and financial performance.
  • Assist clinical operators and companies serving the health care industry in developing business plans including marketing and financial plans.  Prepare revised plans in response to market changes.
  • For clinical offices, review policies and procedures involved in documentation, coding, billing and collecting payments for clinical services.  Develop policy and procedural changes to improve patient and customer relationships, reduce billing errors and improve collections.
  • Conduct focused reviews of clinical and billing records to identify possible coding and/or billing errors. Train clinical and administrative staff in proper documentation, coding, and billing and develop policies and procedures to ensure correct coding and billing.

Typical projects include:  

  • Assisted a five-physician practice to restore profitability following losses incurred during a computer conversion and as a result of staffing inefficiencies and low reimbursement rates.
  • Reviewed the operations of a four-physician practice prior to its acquisition to identify and correct operational inefficiencies. Recommended changes in its financial operations including updating the charge master, enhancing computer support and billing and restructuring the physician compensation program to improve profitability and productivity.
  • For an unprofitable specialty HMO, reviewed its growth strategy, financial planning, marketing, and medical management functions. Recommended a refocused strategy and revised marketing targets, improved financial reporting, and planning, focused medical management, several personnel changes, and increased board oversight.  These changes made the organization an attractive takeover target and it was sold to a larger managed care organization.
  • For a home health services provider, researched the market for case management services. Recommended that they seek other opportunities.
  • For an international pharmaceutical company, researched the market for specialty health insurance in areas where they had leading therapeutic products and drugs. Recommended that they not enter the insurance business, but, if they wished to proceed, to consider a joint venture.
  • For a medical billing adjudication and collections company, assessing the feasibility of converting proprietary internal software to a claims adjudication product for small HMOs, TPAs, and IPAs with multiple risk contracts. Not feasible. Company sold.

Katz and Associates Manged Care Services include:  

  • Evaluate existing and proposed risk contracts to assess their potential profitability based on the provider's utilization patterns for the same or similar populations. Recommend contract modifications, when necessary, to improve the provider's performance.
  • Negotiate risk contracts for providers.
  • Assist providers (physician organizations, IPAs, PHOs or hospitals) in developing programs to track performance and manage risk. Prepare business plans, if needed.
  • Review contract performance, identify improperly paid claims, underpaid claims and denied claims and assist the provider in recovering improperly withheld funds.

Typical Projects for Providers  

  • Using parameters for "acceptable contract terms" developed with the client, and a "model" of past utilization for the population to be served, successfully negotiated risk contracts with the primary and secondary payers in the service area.
  • Assisted an IPA and a PHO establish their medical management and administrative structure to manage risk. Developed business plans.
  • Reviewed contract performance for a large multi-hospital PHO, identified improper payments to providers from the risk pool and negotiated a favorable year-end settlement.
  • Assisted a physicians' group negotiate a favorable settlement of withhold and surplus returns from a teaching hospital-based managed care network.

For Companies Serving the Managed Care Marketplace.
Katz & Associates assists companies evaluate new products and services. Assignments have included:  

  • Evaluation of the market for a stand-alone case or disease management service to managed care organizations and/or providers holding risk contracts.
  • Market tested a computer-enhanced physical therapy video product whose success depended upon acceptance by providers and managed care organizations.
  • Assessed the market for disease-specific health insurance carve-outs for an international pharmaceutical company.

For Managed Care Organizations.
Katz & Associates occasionally assists managed care organizations. Assignments have included:  

  • Conducted a management and market assessment of a provider-owned psychiatric and EAP managed care company. Recommended changes in leadership, medical management, financial management and reporting, service profile, and marketing, and positioned the company for sale to a larger managed care organization.
  • Assisted a staff model HMO develop plans for entry into the IPA marketplace.

We would be pleased to provide additional information on these and other projects and client references. Please contact us at the address or phone numbers listed to the left.