Managed health care business management consulting, finance, development and health care financing administration services

Financing assistance for managed care companies

Like everyone else is business, those who provide health care or managed care can never afford to lose sight of the bottom line. Our financial experts can help you make the most of existing funding and investment opportunities. We can also assist you during audits and investigations.Visit this section to learn more about the following:

• Funding
• Banking and Funds Management
• Investment Opportunities
• Audits and Investigations

Funding

If your company needs investment partners, AMG will assist you in preparing the offering materials, help identify potential investors, and participate in presentations and negotiations. If your company has multiple investors, AMG will set up and train your staff on the operational management, and tracking of funds and stock. contact Allied Management Group today to learn more about how we can assist you with:

• Investor programs
• Tracking and stock management
• Investor seminars and presentations

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Banking and Funds Management

Choosing the right banking relationship is essential in meeting your company’s goals. AMG’s professionals have extensive banking background, including expertise in areas such as:

• Banking relationships
• Optimal funds return
• Service off-set

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Investment Opportunities

Whether you are looking to buy or sell, AMG can assist you in the identification and evaluation of potential strategies, properties and business relationships. Among the many areas of interest are:

• Mergers, acquisitions and sales analysis
• Purchase and sale of trust deeds
• Real estate acquisitions
• Identify opportunities
• Review and analysis of prospective acquisition and joint venture candidates
• Due diligence
• Tax consulting, and purchase accounting consulting
• Casualty and property risk assessment

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Audits and Investigations

AMG’s years of claims experience can assist you in auditing your companies processing of health, worker’s compensation, life and disability claims including medical, prescription and dental, all in an effort to stream-line processes and security protection. Our audit will address all facets of the claims operations including the most common errors, i.e., incorrect paid claims, non-benefit compliance, subrogations, coordination of benefit errors, extension of benefits of prior carriers, unqualified members/insured and workers compensation.

Prior to contracting with a prospective administrator, AMG will complete the due diligence to assist you in determining the potential relationship.

AMG has worked with many insurance carriers and attorneys representing providers in suspected insurance fraud cases by reviewing the data. We can also serve as expert witnesses in some cases.

Trust funds are a high-risk area that can close your company with the slightest mistake. Taking time to review the trust funds are time consuming and tedious, and tend to be delayed because of more pressing daily issues. Trust fund audits include reconciliation to the accounts receivable (groups or payors), the computer system tracking the data, the claims system membership (including retro adds and deletes) and bank accounts.

AMG will identify erroneously paid medical, dental and pharmacy claims and assist in the recovery of the funds.

ADMINISTRATORS

• New administrator audit and review
• Processing and interface procedures
• Underwriting guidelines
• Operational and procedural reviews
• Claims procedure review
• Quality control programs
• Utilization management and cost containment

CLAIMS ADJUDICATION

• Claims processing systems, review and procedures
• Benefit compliance
• Eligibility determination
• Claim documentation
• Liens and coordination of benefits
• Relative values
• Diagnosis consistencies
• Provider utilization
• Medical review and investigations
• Reinsurance audits and shock loss review
• Claims negotiations
• Medical algorithms

SUSPECTED FRAUD AND ABUSE

• Medical, dental, worker's compensation and prescription
• Insured non-disclosure and claims falsification
• Federal and fraud abatement compliance
• Insured and provider collusion investigations

TRUST FUND AUDITS

• Group billings and receivables
• Commissions payments
• Bank reconciliation
• Claims disbursements
• Capitalization reconciliation

LAW FIRM CLIENT AUDITS

• Client financial audits
• Medical practice insurance fraud
• Errors and omissions
• Litigation and judgment audit

ACCOUNTING, TAX SERVICES AND AUDITS

• General ledger
• Accounts payable and receivable
• Payroll
• Tax: corporations, partnerships, sole-proprietors, payroll, transient and sale

For more information on how our health care business management and consulting services can improve your bottom line, contact Allied Management Group today.

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Managed health care business management consulting, finance,
development, and health care financing administration services.