“A good puzzle, it's a fair thing. Nobody is lying. It's very clear, and the solution depends just on you.”
Insurers’ contracts can be thought of as puzzles. However, according to Rubik’s quote they may not be “good” puzzles. If you think what Rubik says might be true you must determine if the contract is good for your organization. The insurer may not be lying, but if they say they’re giving you a 5% increase how do you know it is really 5% and not 2.4%? We recently saw that exact situation with a client? Trust, but verify. The only way to know is to model the contract.
The key to successfully negotiating and monitoring your contracts (both government and non-government) is having an accurate expected payment calculation for every patient that comes to your organization. In order to accomplish this, you need a way to take the pages and pages of often puzzling contract verbiage and quickly and easily translate it into a system to see if the contract will positively or negatively impact your bottom line. The reimbursement methodologies are so complex you can no longer rely on Excel or legacy billing systems to give you accurate calculations, especially in your outpatient business. That’s where Kreg’s CMA product shines.