In the changing landscape of US HEALTHCARE FINANCE AND THE accountable care act payers and providers are collaborating more than ever to deliver value and developing new payment models that incorporate this partnering phenomenon. Providers are finding they need very sophisticated tools to monitor the correctness and completeness of their patient care payments. Additionally as margins thin out, providers are scratching for every cent owed and enhancing their analysis of A/R by Payor.
for years Contract management systems have modeled expected payments from payers under established payment regimes like DRGs, fee schedules, percent of charges and Per Diems. Now many of the existing contract management systems are being expanded to model new payment equations such as reference pricing, population management fees, shared savings models and bundled payments.
Although many providers have contract management systems in place many of those are outdated, or incompletely installed.
This lecture will be most beneficial to providers whose current system is underutilized, under resourced or misunderstood AS WELL as providers who do not currently have a contract management system.
We will look at what's needed to install one of these systems for the following purposes: contract negotiations, underpayment identification, netting down A/R to net realizable value. We will examine the relative cost, time and effort to install or update a contract management system foreach of these purposes as well as the pros and cons of each approach.
Glen Gill CHFP, MHA
Glen has over 30 years experience with managed care contracting working with large teaching hospitals and regulatory agencies contracting both sides of managed care agreements.