Streamlining a Health System’s Contract Analysis Process

Data From:

Epic

After working with PDS, our fee schedule analysis went from a two-to-three-week struggle to a two-to-three-day task. We knew there had to be a more efficient process; it was just a matter of having the right tools.

Background

A southern health system was dealing with a payer contract and reimbursement analysis process that was primarily manual, time-consuming, and cumbersome. The organization labored to quantify the effects of proposed contract fee schedule changes and to model predictive scenarios to anticipate potential losses. When asked about his organization’s challenges, the CFO said, “Our contract analysis process didn’t give us any foresight. It was difficult to anticipate changes and potential risks.”

Results

With PDS Contract Analyzer, the organization was able to model proposed fee schedule changes against historic utilization to determine the impact of the new fees. The ability to load new annual rates quickly and easily greatly improved the health system’s ability to quantify the financial impact of changes positioning them to negotiate from a position of strength. PDS Contract Analyzer also allowed for easy comparison of payer contract performance across all volumes.

By working with PDS, they streamlined their contract analysis process, which allowed the organization to:

• Easily identify payment variances to expected contract amounts on major contracts
• Compare contract rates against the Medicare RBRVS values to benchmark payer performance against Medicare as well as other major contracts
• Compare payer contract performance across all departments, divisions, specialties, and even providers
• Apply modifier adjustments and provide RVU values for unlisted CPT codes
• Perform analysis on fee schedule changes in two-to-three days instead of two-to-three weeks