PAYOR CONTRACT ANALYSIS AND NEGOTIATION: LEVERAGING THE INFORMATION AT YOUR FINGERTIPS

PRICE TRANSPARENCY AND 835 PAYMENT DATA

• Have you evaluated your third-party payor contracts lately? 
• Do you have any contracts coming up on renewal?
• Have you compared payments across payors for consistency and adequacy relative to costs across service areas?
• Do you have appropriate carve-outs for costly services and/or items (specific case rates, implants, drugs)?

All the efforts put into meeting the CMS Price Transparency requirements has created the ideal platform to examine and reevaluate payor rates across procedures and service lines.  This information can give you a baseline of favorable and unfavorable payment terms by specific procedure, service, or episodes of care and isolate payor patterns of reimbursement terms that fall outside of reasonability relative to the full population of payors covering your patient population.

Coupling 835 payment and denial data with emerging findings and patterns from the payor price comparison can also aid in formulating a strong discussion and if possible, renegotiation plan to take to the table with any health plan.

MedCom can help you with the analysis process in succinctly leveraging both Price Transparency and 835 data for your facility.  Our analysis can help you identify a matrix of winners and losers by procedure/service area, or episode of care and establish a well-laid plan for payor talks and negotiation based on the results of the analysis.

Additionally, because we largely use 835 payment data as a solid foundation for your payment experience by payor, an opportunity exists for you to explore other areas for trending and revenue improvement (such as denials analysis and key payment indicator monitoring) through MedCom’s 835 Payment Analytics service.

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Our Chargemaster, Pricing, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.

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