“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.
Solving the Puzzle with Kreg’s CMA
Kreg makes it easy as possible to build complex, accurate contracts. The system is designed for end users without technical or programming skills. Our process focuses on organizing contracts into simple to understand logical building blocks which are connected for calculating claims. These blocks are segmented to Contracts (Payer or Payers), Provisions (Inpatient, Outpatient, etc.) clauses, terms, and conditions. You may apply thresholds, maximums, and minimums at any point in the calculation. (See Figure 1 below for a synopsis of a typical managed care contract from the system.) The end result: you will be able compare contract blocks across payers and services as seen in Figure 1.
Figure 1: Building blocks across service lines
Then you indicate the exact order in which these blocks are to be calculated, as shown in Figure 1. This allows you to build complex calculations quickly. CMA’s user interface makes this easy to do. You don’t have to know anything about SQL or database administration because CMA’s clever user interface shields you from all that complexity
To increase your contract building speed you may copy, edit, and reuse contracts, in whole or in part. Then you simply replace the rates and fee schedules by uploading Excel files that are stored in one central location on the server.
Contract maintenance is the heart of a contract management system. CMA will save you time in building, loading, and maintaining your contracts. Kreg takes care of the Medicare contract for you, as well as APC and eAPG contracts. You can either maintain all your other contracts, or hire Kreg to take care of that as well. The typical installation will have 10 to 50 contracts on their system. Most contracts take from two to four hours to build, and extremely difficult contracts may take a few days to build and verify.
Contract Building: the Key to Simulations
CMA’s contract building flexibility really makes contract negotiations easy. Just copy this year’s contract, load rates, replace thresholds, maximums, and minimums and you’re ready to calculate. What used to take days or weeks can be accomplished in a few hours.
The best part of the Kreg approach is that you can compare these business lines across payers and contracts by building your contracts in a standard fashion, like Kreg does. In fact, you can compare lines of business across payers even though the payers have different reimbursement methods.
For more information on Kreg CMA click here