Getting Started Page
Thank you for choosing Healthcents, Inc. to assist you in taking steps toward achieving better reimbursements from your commercial insurance contracts. In preparation for your project kick-off, please take a few minutes to compile your payer data and complete a brief questionnaire that Healthcents will use to prepare an impact proposal letter to initiate negotiations on your behalf. Below are the instructions and files to use. Thank you for your help in preparing for negotiations.
Please download and print this document which provides detailed instructions about how to successfully load RevolutionSoftware: RevolutionSoftware Getting Started Instructions.
There is one document, the physician or ASC questionnaire, one chargemaster file and one payer allowable file (for each payer) that needs to be completed. The following files should be downloaded and completed:
1) Provider Questionnaire (Submit one, only, based on the entity type below, items a-e):
The provider questionnaire is designed to enable Healthcents to represent your practice or company with payers and to position your practice or company in a positive and differentiated way compared to your competition. Particularly when answering the product / service differentiation question in all questionnaires, we have found that if you can elaborate benefits in one more of the following areas, we will be able to differentiate your products and / or services from your competitors and, therefore, be able to explain the benefits to the payers about your practice or company:
- “Biggest and Best, One and Only“: Depending upon the kind of provider you are, being the largest full service provider in your area may in fact carry weight if you have a unique specialty, unique services and / or well known practitioners with referrals working for your company or practice. If you can further back this up to demonstrate outstanding clinical outcomes or other results such as high compliance (DME products) being the “biggest and best” can be a differentiator. Also, being the only company that provides products / medical services in a region can be a differentiator.
- Product– e.g., if you have a unique device or deploy a unique device that other competitors don’t have, this is a great product differentiator. Anything along these lines that is unique and provides better clinical outcomes helps.
- Service– e.g., if you have therapists to go to people’s homes to help them get the most out of their equipment and better compliance rates compared to competition, this would be a great differentiator. Speed of delivery, door to door service (DME companies) are all worth mentioning.
- Clinical Benefits– Is there any evidence based data that shows your deployment of HME equipment produces better clinical outcomes when combined with your service than other similar companies? If you are a practice, can you demonstrate better treatment results, surgery avoidance, reduced hospital readmissions etc.?
- Geographies serviced– Do you service rural areas or patient populations that others don’t?
- Referrals and out of network business– Are you doing a large book of business out of network with a payer(s)? Do you have empirical information / data to demonstrate utilization? Are hospital systems and large groups referring business to you?
What about Price as a differentiator? Generally, price alone will not be enough to help you get into a closed or narrow network. However, price coupled up with one or more of the items, above, will indeed help.
Please complete ONE of the following questionnaires based on the type of provider that you are?
a) The Physician Questionnaire (For Physician Practices and Hospital Based Physician Groups): click here to get the Physician Questionnaire
b) ASC Questionnaire (For freestanding or outpatient hospital surgery centers): click here to get the ASC Questionnaire.
c) DME and O and P Provider Questionnaire (For DME and O&P Companies): click here to get the DME and O&P Questionnaire
d) Pharmacy Provider Questionnaire (For any pharmacy provider): click here to get the Pharmacy Provider Questionnaire
e) Ancillary Provider Questionnaire (For any ancillary provider): click here to get the Ancillary Provider Questionnaire
2) The Provider Profile template: click here: Provider Profile Template
3) The Chargemaster File, click here: Chargemaster (Column D, location and modifier (TC and 026), should not to be completed for ASCs, DMEs and other ancillary providers). Only submit one of these files.
4) The Payer Allowable File, click here: Payer Allowable (Columns D and E, location and modifier, TC and 026, are not to be completed for ASCs, DMEs and other ancillary providers). Copy this file N times for each payer to be analyzed. For example if you are analyzing three total payers, you will submit 3 copies of this file.
- Please use the payer allowable file in item 4, above, to make additional copies, as needed, to populate for each payer to be benchmarked or negotiated. The chargemaster and payer allowable files provided, contain two rows of sample layout of the CPT code data required. Please follow this format exactly, do not spell out the word office, change formatting etc.
- You may use alpha and number codes, CPT and HCPCS. However, only physician services and ASC codes will have automatic Medicare rate look ups. Designate site of service with an O if the procedure is performed primarily in the office setting or F if it is done in the ASC or Hospital setting most often (If you are an ASC then you did not need to fill in this field). It is okay to list the same code twice, once for each site of service, but provide the volume (number of encounters) separately, as well. Provide your contracted global payer rate. Keep in mind that the benchmarking tools are designed primarily to evaluate PPO Point of Service agreements. Note that there must be no 0 values in either the volume field, billed charges or payer allowable fields, leave blank if the value is 0. You may use global rates, professional rates, 026, and technical component rates, TC. If using global rates only, fill in the chargemaster and payer allowable files exactly as illustrated above. If you would like to add professional rates and technical services components for applicable codes, i.e., Radiology, the use column D of the chargemaster and column E of the payer allow able file and simply specify 026 for codes that have a professional component and TC for codes that have a technical component.
5) List of high priority contracts to negotiate: click here for template to complete If your practice or company has multiple entities with separate Tax ID numbers and NPI Numbers, please be sure to list your order of priority including all entities and payers to be negotiated.
It is recommended that you use the top codes that represent at least 80% of your practice’s book of business. In our experience, this is typically your top 30-40 surgical and E and M codes. Ultimately, the code group selection should be a compilation of your top codes based on your most expensive and most frequently performed. We recommend focusing on your top 40 based on multiplying the volume and payer contracted rate. If you plan to perform comparative analysis, across payers, you may want to consider using the same set of codes for all payers you that you will be negotiating/renegotiating. In any event, you must have all codes to be analyzed in your chargemaster. You may have a subset of codes in your payer allowable file(s) but, if possible, for consistency it is best to use the same codes selected across all files and simply leave values blank in the payer allowable files, when they are not needed for that payer.
Healthcents, Inc. will use the data and information that you provide along with anecdotal information to prepare a focused proposal letter for your approval. Once approved by you, we will commence negotiations and we are “off to the races”.
Please send your data file(s) and completed questionnaire to your Healthcents Account Representative. This information will be provided during your kickoff call. If at anytime you have questions, please send an email to email@example.com.
From our team to yours, thank you and welcome!
CEO / Co-Owner, Healthcents Inc.
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