Two Practices, One Solution

The real value of contract management products? They value the claim as soon as it hits the system, tell the provider what it will likely be paid, and compare the claim to the EOB. Providers know immediately if they have to follow up.

Underpayments come in two types—denials where nothing is paid, and payments that are not what they're supposed to be. "We track those monthly," says Tacker. "What has been appealed, been denied, been successful and what is still pending—and we can look it by specialty and provider. We've seen about a 1.5 percent increase in net payments for about $1.5 million extra dollars."

Tacker uses the contract analysis module of Phynance to perform "what if" scenarios when getting ready to renegotiate a contract. Connor, who is just going live at Lake Charles, is looking forward to using that feature soon. "For a new contract, I can plug in what it's proposing, and model it side by side with existing contracts."

Her plan is to go back to the table with payers for contract negotiation—“You promised X and you're delivering Y, what do you plan to do about it?" Connor adds the only way to do that is with the data.

Tacker is already tracking success in her appeals. "Your gut instinct tells you there's a particular payer you're always having problems with, but you need more than a gut instinct to go to the table. If I see lack of success, that may be a payer I don't want to do business with in the future."

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