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. Exela provides multiple scenarios, utilising 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, Managed Medicare, Managed Medicaid, Traditional Medicare, and Tricare.
The majority of healthcare providers do not utilise a sophisticated system necessary to handle and meet their required needs and expectations. Exela has the system that can and will meet such.
Exela begins the process by loading all contractual agreements, calculating the expected reimbursement for your current and future agreements utilising 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.
Utilising our professional staff of 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.
Exela’s query and reporting capabilities allow you to analyse 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. Exela 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. Exela’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 University Facility in Ohio
- Aetna supplied rate proposal representing a proposed 5.5% increase or £5,000,000 per year. In fact, the offer was Budget neutral. Exela supplied rate structure reflecting a true 5.5% increase, thereby securing additional £15,000,000 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?