CHARLOTTE, NC – Hospitals are increasingly turning to IT solutions versus changing rates to improve revenue, said David Tourville, healthcare analyst for PayStream Advisors.
Providers are finding that contract management is one IT solution that can address revenue issues.
In a PayStream Advisors survey of chief financial officers and revenue cycle managers, the number one pain point cited in the revenue cycle area is denial management as it relates to contract terms.
The top pain points for contract management mentioned were manually reviewing payment compliance retrospectively and contract modeling. Automating the process through a negotiation tool allows hospitals to optimize terms and improve overall collectibility.
With contract management tools, hospitals can take historical data from payers and facilities and give providers an internal perspective on how new contracting terms can benefit them. With so many different terms that need to be written into contracts, hospitals can benefit greatly by implementing a tool to evaluate the contract and automate the process.
Approximately 65 percent to 75 percent of hospitals have some form of basic contract management, according to Tourville, and the interest in more advanced tools is rising. “Contract management is a time-tested system that has adapted to new interfaces and is user-friendly,” he said.
Hospitals are also dealing with numerous reporting and measuring changes in their base contract language, said Anthony Roth, senior director of product management for I-Many.
The overall goal is to build in standardization to remove risk and maverick contracts. “If you have pre-approval for language, the risk goes down,” he said.
Jodi Bloom, RN, principal of Bloom Road Consulting Group, said external forces are changing the market. Managed care drives contract management because of the regulatory agencies’ reimbursement mechanisms.
The reimbursement process is getting more complex with the various mandates coming out, said Bloom.
The major change in the Medicare Diagnostic Related Group schedule, which was made as a final rule in August, changed the meaning of codes and increased the number of codes from 500-plus to 800 codes. “Everyone’s system has to be changed,” said Bloom, and that will impact hospital contracts.
Hospitals will turn to contract management tools to automate the process of converting the new codes into their enterprise system.
Some hospitals purchase a contract management module that is a bolt-on to their core enterprise system while other hospitals look for the best of breed.
If the systems are separate, said Bloom, maintaining expertise in-staff can be a challenge. Hospitals need to consider if they have the resources to maintain a best-of-breed system.
Whichever solution they choose, Bloom said that opportunities for return on investment are many. One way to recover revenue is through retrospective audits that contract management tools produce. Hospitals can run reports and compare actual payment to contract terms, she said, making contract management software a valuable tool to look for lost revenue.
Accuro Healthcare Solutions
Accuro Contract Manager, Accuro Contract Manager PRO, Accuro Rapid Reserves, Accuro Denials Manager, Accuro Receivables Manager
Features: Accuro Healthcare Solutions’ Web-based Performance solutions enable hospitals and large physician groups to identify and collect all revenue contractually owed, monitor and evaluate payer performance to help leverage future negotiations and accurately recognize reserves at month’s end.
Concuity, a Healthcare Division of Trintech
ClearContracts
Features: ClearContracts for hospitals and ClearContracts Pro (for Professional Groups) are Web-based applications designed to fit into a healthcare organization’s revenue cycle management plan. ClearContracts enables all types of healthcare providers to analyze contract performance, verify expected reimbursement and enhance the financial profitability of new and proposed payer contracts. Concuity offers an innovative combination of services and Web-based technology to allow customers to quickly gain control over payer contracts and help them to immediately recover lost revenue due to underpaid claims. As a result, ClearContracts improves contract performance and visibility while enhancing cash flow and profitability.
I-many
I-many Contract Authoring
Features: I-many Contract Authoring allows organizations to automate the entire contract management continuum from create, store and manage to alerts and notifications on key business events and milestones. This allows for granular and collaborative authoring, both on a contract agreement level and on an individual contract section. The solution lets users easily configure workflows to streamline and improve contract processes, reducing the time it takes to finalize an agreement. I-many Contract Authoring supports all business functions including Sales, Procurement, IT, Intellectual Property and other legal processes. From creation to end-of-life, I-many Contract Authoring implements suggested best practices to contract management organizations.
IntelliSoft Group, Inc.
IntelliContract Windows | Web
Features: IntelliContract, contract management software, provides visibility, proactive reminders and effective business controls across the enterprise. This helps drive better management decisions and turns contracts into effective management tools. IntelliContract, contract management software, streamlines the entire lifecycle for any type of contract or business agreement – from initial negotiation, creation/authoring, managing, searching, tracking, reporting and more.
IQNavigator
IQNavigator 8.0
Features: IQNavigator provides a highly configurable platform and solution offering, enabling rapid application to each customer’s business process and fast return on investment.
Kryptiq Corporation
Choreo
Features: Kryptiq’s Choreo suite transforms provider contracting and network management processes providing the organizational flexibility and system transparency to competitively grow and manage provider networks in response to shifting market dynamics. Choreo automates contract creation, streamlines negotiation and manages provider demographics and rates to provide system-wide visibility into provider network information. This enables health plans to improve today’s inaccurate and inefficient provider contracting processes, reducing risk and cost per claim, and enabling rapid product development and market expansion.
McKesson
Pathways Contract Management
Features: The Pathways Contract Management solution automates the contracting and reimbursement process, including monitoring payments from payers, updating accounts receivable and performing what-if contract modeling analyses across all payers to strengthen contract negotiations.
MediTract, Inc.
TractManager, COIDS, TERMS
Features: MediTract is the leading contract management service provider exclusively serving the healthcare industry, and currently works with hundreds of hospitals and healthcare systems at thousands of locations nationwide. The company’s solutions help healthcare professionals regain control of their contracts and reduce the cost of doing business by providing the tools necessary to improve management’s visibility of contractual obligations, enhance compliance and streamline workflow. This innovative, money-saving service is well suited for healthcare organizations of all types and sizes.
Preferred Medical Marketing Corporation (PMMC)
PMMC Contract PRO for Hospital contract management, PMMC Physician PRO for professional/Physician contract management
Features: PMMC offers a contract management solution for hospitals and physician organizations that is built on 21 years of experience and a proven robust Microsoft SQL platform. Modeling prospective contractual terms, reimbursement variance monitoring, flexible reporting and an open-relational database delivers a true comprehensive system. PMMC’s services are customized to each client’s needs, staffing requirements and budget concerns. PMMC delivers both quantitative benefits such as the most competitively priced system, high recovery results, and a guarantee to handle all payer reimbursement calculations, as well as qualitative benefits such as superior support services, flexible implementation options, ease of use and user-led enhancements.
Procuri
Procuri TotalContracts
Features: Procuri TotalContracts incorporates a highly intuitive user interface with robust functionality including Contract Management, Contract and search repository and Contract creation.
TPMS, Inc.
Harvest Contract Management System
Features: Harvest provides key tools for successful revenue cycle management, including 100 percent vendor setup and ongoing maintenance of all payment rules. Harvest offers Underpayment identification and recovery tracking, Denials Management analysis and recovery, Consumer Pricing Estimates, Contract Negotiation Modeling, proposed Medicare Reimbursement Modeling, Data Mining and Specialized Reporting, Data Integration with decision support systems, Charge Maximization and Fraud/Abuse Testing.