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What Is Contract Modeling in Healthcare

Once communication between departments has been streamlined through a single data system, the next step is to use the data to assess payer performance under the current contract. To help us get started, here are two common examples of performance measurement: Syntellis` Axiom™ Contract Management can help healthcare professionals automate key contract management processes, such as contract tracking. B assessment of the revenue impact of new/modified contracts and compliance. The software provides information to support contract negotiations using facts to avoid contentious interactions and support positive working relationships with payers, providing an overall benefit for key contract management processes. Modeling the impact of proposed reimbursement terms using historical hospital data provides accurate projections of usage and expense patterns. Easily project effective discount rates for a true side-by-side comparison between different contract terms, including Medicare, and current contract rates and terms. Brad Olin is a Marketing Communications Specialist at PMMC, a leading provider of revenue cycle management solutions for hospitals and other healthcare organizations in the United States. Brad provides a modern perspective on the evolution of the healthcare industry and the general practices used to increase the health of a company`s revenue. Increase your net patient turnover by identifying and eliminating underpayments and illegal denials in healthcare. 3: In addition to the window of time to oppose rejections, suppliers should know the exact deadlines for the recovery of refusals and insufficient payments. Not knowing what these windows are, or missing them repeatedly, can cost the installation valuable revenue. By understanding the impact of these different scenarios, providers can be better equipped with actionable data in contract negotiations with payers.

Without this relevant information, suppliers blindly engage in negotiations or use data from simple analyses that don`t delve deeper enough into the details to be effective. As a result, contract management teams are not able to negotiate as effectively as they would if data were more accessible. In early 2019, the healthcare system`s largest commercial payer unveiled a new contract that would bring in $12 million a year to Owensboro Health. In the past, this would have led the healthcare system`s managed care team to several months of data processing using manual methods such as spreadsheets and traditional financial management software. Owensboro Health, a two-hospital health care system based in Owensboro, Kentucky, like all U.S. health care systems, faces ever-changing reimbursement methods. Recent payment models such as bulk payments and COAs, as well as more complex contracts and general uncertainty about future changes, have led Owensboro Health to rethink its strategies for maintaining financial viability. Today, Mission Health analysts are using a contract modeling tool to increase efficiency and produce more actionable data that will be used to evaluate contract performance and negotiate more favorable contract terms, Chipriano says. This time, Owensboro Health knew that to remain financially viable, it needed to find a better way to understand both what its services cost the health care system and what those services earned. The healthcare system decided to take the opportunity to test the effectiveness of a new contract modeling module of its cost accounting platform from Strata Decision Technology, a provider of cost accounting, financial analysis, benchmarking and other technology software. As a tool that analyzes both costs and revenues, contract modeling is essential to prepare for change.

By adopting and adopting this proactive approach, healthcare organizations can gain efficiency and transparency about what change means for their profits, and are better financially prepared to meet the current and future needs of their patient populations. .

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