Bloom Road Consulting Group helps you to assess how well you are using your Contract Management System

A tune-up provides education for staff and the opportunity to identify revenue for recovery.  By using a systematic method to evaluate system goals, setup, and implemented functions, your Contract Management System can provide you with the return on investment you hope for.  Allow us to walk through this tool to help you improve your bottom line.

    1)    What is the role of your Contract Management System in the Revenue Cycle?

a.    Roles of Key Users; Knowledge, Skills

b.    Host and Interfaces

c.    Contract coding

d.    Reporting

2)    What are the current system goals?

a.    Implementation Goals

b.    Identification of Underpayments and Denials

c.    Measure and manage Contractuals and Payments

d.    Payor performance, negotiation

3)    What Contracts are Set up?

a.    Production:

                                          i.    Managed Care – Capitated, PPO, Silent PPO

                                         ii.    Medicare

1.    Inpatient

2.    Outpatient – APCs?

                                        iii.    Medicaid

                                       iv.    Champus

                                        v.    Workman’s Comp

                                       vi.    Self Pay

b.    Test or Modeling Database

                                          i.    Methods

                                         ii.    Options

4)    What are the reporting needs?

a.    Currently in use and documentation

                                          i.    Paid, Unpaid, Unbilled

                                         ii.    Variance

                                        iii.    Aging

                                       iv.    Payor Performance

1.    Volumes

2.    Expected vs Actual

                                        v.    End of Month reporting

b.    Reporting methods

                                          i.    Crystal

                                         ii.    RPT

                                        iii.    J parameter, stored procedures

                                       iv.    5r, SQL

                                        v.    Cube

5)    What is critical in ongoing Table Maintenance?

a.    Insurance Table

b.    CDM, usage code and flags

c.    Daily Interface Monitoring

6)    Who manages security issues and filesystem maintenance?

7)    Other questions and concerns?

P.O. Box 2469  · Eagle River, WI 54521· ph: (615) 373-1466 Fax/VM: (888) 297-9240  
Copyright © 2010 Bloom Road Consulting Group LLC

Last modified: 05/02/11