Reimbursement Assessment
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The Revolution Has Begun!

Healthcents Physician Contracting has been in the trenches negotiating and valuating health care contracts for clients since 1994. Now, we bring our experience and expertise to bear by arming you with the tools to easily and conveniently access the same kinds of data and information that payers are looking at in negotiations.  This tool can help you substantially increase your revenues by providing the knowledge that you need to be effective in a negotiation.  Even without negotiations, charge master adjustments, and our out of network modeler often will increase revenues when the information provided is put to work.


RevolutionSoftware BENEFITS:


1.      RevolutionSoftware is the only web service that majors in provider contracting analytics, therefore, it is the only tool designed to maximize commercial payer reimbursements.  (Billing Software is complementary, that is, it focuses on insuring you get paid fast and accurately).


2.      Only web based tool to benchmark reimbursements by CPT code- compare payer reimbursements for the same CPT codes on a normalized base of volumes for each code across any two payersObjectively assess in vs. out of network options on each commercial payer contractModel your charge master to be sure that you do not fall victim to "lesser of billed charge vs. payer allowable" languageCompare a sample of claims payments to contract allowables to assess whether or not you are under paid on existing in network agreements.


3.      RevolutionSoftware is complementary to a billing system and enables you to compare disparate fee schedules and calculate the relative revenue differences based on using the volumes of a selected payerWhile your billing system may have much of the raw data, it is not readily able to assess and compare payer fee schedules’ revenue impacts in a consistent way.  For example, if I have a 99213 office visit paid at $100 and performed 1000 times in a year from payer A and the same code paid at $50 but performed 2000 times at payer B, both payers generate the same revenue, $100,000.  However, the potential is that payer B is 50% under reimbursed.  To compare apples to apples, you have to find the intersection of all codes in both agreements and compare the reimbursement revenue based on the volume in one or the other.  Billing systems are not plumbed to look are your reimbursement this way.


4.      Business Modeling:  Further, RevolutionSoftware allows you to readily identify your top codes based on volumes and contracted rates and enables out of network and chargemaster modeling.


5.      Claims Analysis: Very easy and practical way to compare claims to payer contracted rates using the payers’  comparison function and quickly determine under payments by sampling actual payments vs. contracted rates for your top codes.


6.      Differing code mixes across payers:  You will find that there are differing code mixes across payers and RevolutionSoftware will normalize code mixes and allow you to accurately assess the relative value of payer agreements.  For  example: if code 52000 is in payer fee schedule A and not in B, then we would not want to “count” code 52000 in this comparison to weigh the reimbursement value of the fee schedule in relation to each other.  Only codes that are reimbursed in both fee schedules should be compared and then only compared using the volumes of one or the other payer. 



In short, RevolutionSoftware enables you to focus on how to maximize your contracted rates on in network payer agreements and is fed by data which can easily be extracted from your billing system.  It is the perfect complement to your billing system.  The billing system insures that you get paid quickly and accurately while RevolutionSoftware insures that you have the information and analyze it to get paid the highest possible contracted rates on your commercial payer contracts.



Key Features of Healthcents RevolutionSoftware:

  • Payer Rate Analysis: Compares your rates by CPT code to what other providers are receiving from payers for your same CPT codes in your medicare locality, in your state, and across the USA*. Also provides your rates as a percentage of Medicare in your Medicare Locality.
  • Payer Comparisons and Claims Analysis
    • Compares any two payer fee schedules against consistent volumes to determine the codes that need to be moved up, the most.
    • Compare a sample of your claims payments to your payer contracted rates to determine possible under reimbursement
  • Business Models:
    • Out of Network Modeler: Helps you model and compare your current and projected contracted rates in a payer's network vs. out of network
    • Bill Charge Modeler: Helps you to manage your chargemaster rates to insure that bill charges are set at reasonable levels (UCR) for both your in network and cash paying patients
  • Repository: A place to store all of your fee schedules related to payer contracts, on-line, in one easy to find secure location. Internet-based web service with security by client.
  • Other Key Benefits:
    • Only known tool that automates the analysis of provider health insurance contracts
    • Supports Physician and ASC agreements
    • Completely web based:

      * Log on from anywhere, any time

      * No software to install

         - All that is needed to run the tool is a web browser and internet connection

* Data provided where available.