Are you getting paid what you think you should be getting paid?
Dealing with payment discrepancies from your contracted health insurance plans is a difficult and tedious process. How can you pinpoint where payment issues are happening until you validate your contract management system is pricing health services correctly? The first step in the process is to ensure your facility’s internal system and processes are working correctly. Then you can address the external factors that impact pricing.
How e4 helps you maximize payer contracts:
- Review of managed care contracts and compensation schedules
- Analysis of payment variance and denials reports
- Construction of Contract Catalog, Contract Calendar & supporting tools
These steps are proven to maximize payer contracts to increase reimbursement, generate ROI, and maintain effective business processes.
The e4 Solution
|Current system is not equal to the Future System (Do not expect the new system to be like the old one)||New Contract management software is flexible, which makes it complex. The CM software allows healthcare systems/hospitals to build pricing systems similar to health insurance plans. e4 provides experienced and knowledgeable guidance to help through the transition.|
|Self-Sustaining Education (No two health insurance contracts are the same)||Contracts continue to get more and more complex. e4 will help set up various contract templates that can be used to build out all types of managed care contracts. If you are paid a percentage of CMS from a commercial health insurance plan, what does that really mean?|
|No Visualization of Contract Structure||e4 will create and hand over a Contract Catalog, Contract Calendar and other valuable tools as part of the engagement. The contract catalog will be the sketched outline of the new contract management software. It can also be used to share negotiated rates for all contracted health insurance plans with everyone in your organization. Easily compare services to determine how you are paid and what service codes make up a contract term/package.|