Contract Modeling Reports

Similar to the Composite Invoice Comparison report, but provides detail by service type.

• Determines the highest ranking service types
• Identifies service types with a low payment-to-charge ratio
• Displays the calculated reimbursement from each service type

Provides a useful way to review calculations and differences among scenarios in a model.

• Displays calculations for key areas of the contract, allowing a line-by-line comparison of the differences between the baseline and one or more proposals
• Provides reprice calculations for each scenario based on the reimbursement terms
• This report also helps to decipher the effects of reimbursement term changes, which in turn aids in the contract negotiating process.
• Provides cost if cost is submitted by the facility

Note: Provides options for Consolidated Report or Facility Specific Report(s). The consolidated report option is only available for multiple facilities and not available for single facilities.

Consolidates accounts into categories based on the highest ranking service types and displays the calculated reimbursement by the following:

• Accounts with Stop Loss - by patient type
• Accounts without Stop Loss - by patient type
• Accounts with Pass Throughs
• Accounts admitted through the ER
• Provides actual payments
• Provides cost if cost is submitted by the facility

Note: Provides options for Consolidated Report or Facility Specific Report(s). The consolidated report option is only available for multiple facilities and not available for single facilities.

Provides a side-by-side contract comparison for each scenario in a model. The report groups by contract section and displays each time a service type qualified. Numbers are tallied by qualifying times per service type (rather than ranking or reimbursement), so the overall count of accounts is inflated relative to the patient population.

Note: Provides options for Consolidated Report or Facility Specific Report(s). The consolidated report option is only available for multiple facilities and not available for single facilities.

Provides detailed account information for inpatient accounts for each day of a specified reporting period.

Provides detailed account information for Medicare inpatient acute accounts with a breakdown of the components that make up the Medicare expected payment.

Provides detailed account information for Medicare outpatient (OPPS) accounts with a breakdown of the components that make up the Medicare expected payment.

Allows line level detail visibility across all outpatient services. This report includes patient name, patient number, table name/reimbursement method, CPT code, charged amount, group amount, and expected amount.

• If a claim is pricing with EAPG, the full claim is evaluated for EAPG pricing and including codes already priced with different pricing methodologies (fee schedule or other service types). Codes can display twice on the Outpatient Detail report, once for the different pricing methodology and a second time with EAPG.

• This report is only available in .csv file format.

Note: See Contract Modeling Report: Outpatient Detail for additional information on report column descriptions.

This report provides a summary across all outpatient services including the reimbursement method, charge amount, CPT code, service type, and expected amount.

Note: Provides options for Consolidated Report or Facility Specific Report(s). The consolidated report option is only available for multiple facilities and not available for single facilities.

Provides a detailed version of the Revenue Summary by Service Type report. When the cost is greater than 0.00, the following cost columns are included in the report:

• Total Cost
• Direct Cost
• Fixed Cost
• Exp. % of Cost

Note: When the cost is less than 0.00, the cost columns listed above are not included in the report results.

Provides a detailed version of the Revenue Summary by Service Type report and displays each procedure code associated with each account.

Provides account level detail and all components of reimbursement. It contrasts the highest ranking and highest reimbursing service types and the corresponding reimbursement methods (per diem, flat, and so on).

Note: If your facility submits cost information, there is also an option to include cost information in this report.

Provides a summary of pass thru gross charges and expected charges for each modeling scenarios. This report includes the following tabs:

• Patient Detail - reflects the pricing details for each patient. The Pass-Through columns are set to pull the details for the four highest charged pass-through service types, for the first three modeling scenarios.
• Pass Thru Summary - reflects scenarios with qualifying pass-through services. However, all pass thrus are listed (charges and payments) per scenario.

Compares inpatient and outpatient revenue:

• Separates inpatients and outpatients
• Reports aggregate stop-loss information
• Reports Medicare outlier information

Notes: If your facility submits cost information, there is also an option to include cost information in this report.

Provides options for Consolidated Report or Facility Specific Report(s). The consolidated report option is only available for multiple facilities and not available for single facilities.

Consolidates accounts into categories based on the highest ranking service types. Each patient qualifies for only one service type.

A low PCR for a high-cost service indicates a poor reimbursement rate (or possibly an error in the contract profile setup).

Note: If your facility submits cost information, there is also an option to include cost information in this report.