Create and Negotiate the Best Contracts with ClearContracts™
Concuity ClearContracts is a web-based technology service solution that provides healthcare organizations a means to manage the entire contract lifecycle. It goes beyond calculation engines, giving providers the visibility and control they need to create and negotiate the best contracts, streamline contract interpretation and compliance, and collect what’s rightfully owed.
Features
Calculation Engine
Calculate Expected Reimbursement at the Account Level using Charge Detail or ANSI 837 Claim data.
- Charge Detail allows added levels of detail usually unavailable to Calculation Engines.
- Charge Detail can help you to identify billing issues.
- ANSI 837 allows calculation from scrubbed claim data. You can calculate expected reimbursement based on what the payer has actually received.
- Facility Contracts
- Flexible service rule configuration using and/or statements
- Built-in government calculations for Medicare and Champus
- Perform calculations for both inpatient and outpatient services
- Calculate complex stop-loss and outlier terms
- Manage all Managed Care, Medicare, Medicaid and Workers Compensation contracts
- Built-in DRG calculation methods handle special transfer rates and variable per diems
- DRG Regrouping capabilities that regroup DRGs for payers that pay on prior version of DRGs
- Fast Load Feature allows quick upload of fee schedules and rate tables using MS Excel
- Calculate reimbursement based on prior versions of DRGs being used by your commercial payers
- Calculate all ASC, APC,and DRG contracts with ease
- Utilize pre-defined or Customer-defined procedure groupers for outpatient services
- IRF Calculations (Inpatient Rehabilitation Facility)
- SNF Calculations (Skilled Nursing Facility)
- State Tax Calculations
- Prompt Pay Interest Calculations
- Professional Contracts
- Flexible service rule configuration using and/or statements
- Built-in data from CMS - simple point and click selection of rate files
- Ability to turn on / turn off standard Medicare rules for use in commercial contracts
- Perform calculations for both inpatient and outpatient services
- Manage all Managed Care, Medicare, Medicaid and Workers Compensation contracts
- Fast Load Feature allows quick upload of fee schedules and rate tables using MS Excel
- Easy to manage RBRVS, GPCI and Anesthesia Rate Profiles
Revenue Recovery
Identify, Track, and Collect Underpayments and Denials using powerful workflow automation and integrated intelligence and reporting.
- Intelligence Rules
- Classify and group patient accounts where actual payments do not match expected payments based on contract terms
- Assign reason codes to patient accounts to help identify root-causes of payment problems
- Identify and work on only those accounts that are the most important
- Recover contract revenue quickly to reduce the impact of denials and underpayments
- Post collections and promise payments directly into the system for easy tracking and reporting.
- Use assignment logic to route accounts to the correct collector to improve overall efficiency of collection efforts
- Workflow Automation
- Implement efficient processes using workflow automation to trigger dependent tasks
- Improve interdepartmental communication across the revenue cycle
- Work large batches of accounts for bulk appeals and mass correspondence.
- Generate standardized correspondence with online tools and letter templates
- Reporting
- Run custom, ad-hoc reports for immediate results to help track trends and analyze outcomes. Get real time information to drive decisions.
- Utilize standard reports to get system information quickly in a presentable output
Contract Modeling and Negotiation
Optimize proposed payer contracts for greater profitability using actual claim data.
- Utilize all Calculation Engine features to create model scenarios
- Calculate models based on adjusted/inflated charges to accurately project contract reimbursement yield and correctly calculate stop-loss and charge-based rates in model scenarios.
- Use Negotiate feature to summarize post calculated data and dynamically adjust rates
- Store calculated scenarios where they can be easily accessed and adjusted during negotiation to quickly see the impact of a change
- Negotiations complete? Copy model scenario for use in the Calc Engine for current accounts.
- Compare different proposals and scenarios side-by-side
- Compare the value of a proposed contract to the value of the current contract on a service category by service category basis
- Determine contract Yield in a matter of seconds using our online modeling tools
- Facility Contracts
Reporting and Analysis
Deliver powerful reports using our online, built-in custom report writer
- Create custom management reports using any data point in ClearContracts
- Create payer performance reports at the touch of a button
- Create staff performance reports to track productivity within the system
- Set up reports to run automatically daily, week, or monthly
- Deliver rate schedule reports for managed care analysis
- Export all reports to excel or pdf
