A Structured Approach To Payer Contract And Fee Schedule Management

Payer contracts are a road map of revenue for providers. When contracts are negotiated, the rates provide a map with which a physician, medical group and/or manager can forecast revenue. However, inefficient healthcare contract modeling and management can result in the loss of valuable revenue dollars.

Clearly, there are many benefits to proper contract and fee schedule management. When it comes to payer contract management, knowledge is power and planning is essential.

The best tools for payer contract management (our CodeToolz Contract Analyzer) are simple, yet comprehensive. It all begins with a payer matrix for each payer; a one-stop shop for information. Here’s our payer matrix.

Our CodeToolz Contract Analyzer allows practice’s to verify line-item, as well as aggregate, contractually allowed amounts, monitor payer compliance with contract terms, model the financial implications of proposed contracts and much more. This provides the data needed to know exactly how proposed contract terms will affect the bottom line — before signing on the dotted line.

Benefits

Validate Reimbursement Accuracy. Accurately compare expected payment to actual reimbursement.

Simplify Contract Management. When providers centralize all contracts in one location and have firm control over contract details, they find they also have more control over reimbursements.

Recover Underpayments. Find lost revenue with data-driven insight.

Negotiate Better Contracts. Use real claims data to analyze financial impacts of proposed changes and prepare for emerging reimbursement structures. With contract analysis, medical groups can approach payer contract negotiations armed with data to boost reimbursement.

Test Payer Offers. Contract analysis enables medical groups to run “what if” scenarios, so they can better understand how various contract terms will affect payment for the precise mix of services provided. It also allows you to proactively spot unfavorable contract terms, determine targeted negotiation strategies and compare competing contracts (payer market analysis).

Summary

The essential tools of managing payer contracts allow providers to monitor, track, manage and analyze negotiated contract terms and rates. Simplified views of contracts by payer allow for full analysis of contract terms and reimbursements across your organization. When implemented, the tools empower physicians and managers to monitor contract performance and improve revenue. That’s the ultimate goal.

Conclusion

Now that you know how to solve your payer contract management challenges with user-friendly contract analytics and management, it is time to introduce you to the best solution for your needs. That solution is the CodeToolz Contract Analyzer.

Contact CodeToolz today at (877) 464-3005 or email us at info@codetoolz.com to start gaining control of your payer contracts and reimbursements.

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