Contract Analysis

Revenue Integrity

Contract management and analysis is one of the most critical focus points of revenue cycle management to ensure effectiveness and better reimbursement. Hospital Financial Managers need a tool to manage, evaluate and optimize reimbursement to achieve the required returns.

There are three components to the process:

1. The Payer Scorecard – a high level snapshot of denials from your top ten payers

2. Remit Reconciliation – analysis of payments reconciled against contract rate sheet

3. Pro Forma Analysis – comparison of existing terms to proposed terms to analyze the impact

The Scorecard exports an Excel spreadsheet with a summary that displays information by payer including total charges, contractual adjustments, allowed amounts, patient responsibility amounts, and paid amounts. That is followed by the summary of denials, and an analysis of performance by patient type. Users can choose to examine the remittance denial codes within one or more individual remittances, or among all remittances within a date range. This review can be done within the tool, or a package of reports can be exported for analysis. Analysis can be performed on contracts under negotiation by comparing the proposed terms against the current terms, displaying the impact based on the remits received. Each remit is assigned a current contract parent and a Proforma contract, then settled side by side to see how the proposed terms will impact reimbursement. This will provide the hospital a basis for counter proposal to ensure revenue is not negatively impacted with a new contract.