Contract & Reimbursement Audit/Analysis

Hospital Contract Management

Efficiently monitoring each payer’s expected reimbursement is critical. Calculating payer balances continues to grow in complexity. CDR delivers an integrated process for modeling prospective payer contracts to improving future reimbursement and accurately assessing, measuring and capturing all revenue contractually owed with current contracts.
CDR delivers an innovative, process-driven approach that converts data to meaningful information to ensure the accuracy of reimbursement from third-party payers.

Validate Reimbursement Accuracy

CDR’s Contract Management System accurately calculates the payments contractually owed by payer to the provider.…guaranteed. This robust calculation engine handles all hospital-oriented payer contracts including commercial, managed care, Medicare, Medicaid and Tricare. By accurately calculating the expected reimbursement at the time of billing and comparing it to the posted payments and adjustments, CDR CONTRACT PRO pinpoints payment variances quickly and efficiently.

Efficient Recovery of Underpayment

Payment variances are identified through a paperless, seamless automated work-flow process with enhanced Account Management functionality. CDR CONTRACT PRO identifies likely sources of variances including data issues, registration issues, calculation set-up issues, etc. Variance trends are sorted into data views to streamline the analysis process. This provides the ability to focus on true collectable variances versus reoccurring process variances. Having more time for payer communications leads to a more productive appeal process and increased collections.

Negotiate Improved Contract Terms

Industry experts know simulating and forecasting contractual reimbursement during, not after, the negotiation process will improve the overall contract performance. By modeling the various rate and term scenarios, providers are better prepared for contract negotiations. CDR CONTRACT PRO SIMULATOR provides the flexibility to model various rates and term scenarios using your historical claim data. This helps ensure you fully understand the financial impact with your organization and its service / charge patterns, before you sign on the dotted line.

Improve the Management Process of your Payor Contracts

From organizing your payer contracts to monitoring their performance, CDR’s Contract Management applications deliver. Electronic versions of the payer contracts and rate schedules can be stored for easy access and retrieval. Payer contract performance monitoring allows users to track not only reimbursement variances but also monitor the overall financial performance and bottom line effects.

Flexible Implementation

CDR leads the market with implementation options that match your IT/IS Department requirements, staffing needs and installation preferences whether through a local installation approach on the client’s network or a web-based/hosted solution with various support levels to best suit the client’s needs. CDR CONTRACT PRO is also the core calculation engine for other CDR tools. It is designed to work hand-in-hand with other applications such as our upfront patient estimation system, CDR ESTIMATOR PRO, or strategic pricing system, CDR REVENUE MASTER.