Contracts/Reimbursements Management
InsightCS® Contracts/Reimbursements Management enables users to effectively manage and maintain existing payer contracts. These contracts are based on reimbursement rules such as DRG’s, APC’s, etc, and users are able to create models to evaluate perspective contracts utilizing current patient data.
InsightCS® Contracts/Reimbursements Management is completely integrated with other InsightCS® solutions. For example, information from here can be used by Patient Billing to create contractual write-offs based on the contract for the payer. Taking these write-offs at time of billing can dramatically reduce A/R days.
Reimbursement types (DRG, Per Diem, fee schedules, procedure based, APC, percentage, cost outliers, HIPAA) can be defined and set up based on the insurance plan and the patient type. Also, reimbursement rules can be used to calculate for a payer in the absence of a contract.
Features and Benefits
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Ability to true up contractual allowances during payment entry
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Variance reporting including any trued up accounts
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Available data to support appeals report and variance reports
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Maintenance of contract effective and termination dates
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Ability to conduct variance analysis between actual and calculated