IS THE PAYER’S BEST OFFER AN IMPROVEMENT?
Contract modeling is a third party payer contract modeling system. This service includes calculating and providing the accurate contractual reimbursement for future and current contractual agreements. SourceHOV provides multiple scenarios, utilizing the most recent one year patient data set arriving at the net dollar and percentage increase or decrease. This is an extremely powerful and popular tool.
This service includes all contractually obligated payers: managed care, Blue Cross, Managed Medicare, Managed Medicaid, Traditional Medicare, and Tricare.
The majority of healthcare providers do not utilize a sophisticated system necessary to handle and meet their required needs and expectations. SourceHOV has the system that can and will meet such.
SourceHOV begins the process by loading all contractual agreements, calculating the expected reimbursement for your current and future agreements utilizing the most recent one year patient data set. The initial future agreement rate structure is typically supplied by the payer. We arrive at the expected reimbursement under this scenario, as well as, we recommend and produce additional scenarios, based on our extensive payer experience. The flexibility exists to compare not only the payer being re-negotiated, but against multiple payers with whom you currently contract.
Utilizing our professional staff of certified public accountants, registered nurses, and accountants, our recommendations are payer specific, resulting in a minimum 6 figure increase, and we know the additional opportunities exist in your marketplace with that payer.
SourceHOV’s query and reporting capabilities allow you to analyze all reimbursement calculations, request and review pertinent information previously not available, and present all information to the respective payer ensuring increased contract negotiation capabilities. This will lead to and result in increased future reimbursement.
This is an ideal analysis necessary to monitor and compare your existing and future reimbursement performance. SourceHOV works with you and the respective payer to arrive at a future rate structure as well as participate in the actual negotiations, if you so desire.
The data required is easy to obtain. We require little or no staff commitment as we become a subscriber to the current data transmission process. SourceHOV’s fees are either a fixed monthly fee or per agreement fee for an unlimited number of payers and scenarios.
This service typically includes a retrospective and concurrent underpayment and recovery analysis. You may also incorporate the calculation engine.
Recent experiences include:
- Multi Facility Health System in Tennessee
- Blue Cross furnished rate proposal and agreement between parties signed stating the proposed rates would result in an $18,000,000 increase per year. However, after SourceHOV modeled such rate structure, it was determined to be only a $10,000,000 per year increase.. The discrepancy was due to an incorrect patient population being utilized by Blue Cross. Blue Cross incorrectly included secondary claims as well in calculating agreed upon dollar increase. SourceHOV assisting in negotiating and securing our Client the additional $24,000,000 over three years.
- Multi Facility University Facility in Ohio
- Aetna supplied rate proposal representing a proposed 5.5% increase or $7,500,000 per year. In fact, the offer was Budget neutral. SourceHOV supplied rate structure reflecting a true 5.5% increase, thereby securing additional $22,500,000 over three years.
We have 2 questions:
- Is the payer’s best offer truly an improvement?
- Would you like to be able to increase future reimbursement with confidence?