Powerful Healthcare Contract Management

 

We model and manage healthcare payer contracts with turnkey, user-friendly cloud software at a fraction of competitors' prices.

Boost your net patient revenue by identifying and overturning underpayments and wrongful healthcare denials and underpayments. 

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Learn More About the Healthcare Contract Management Software that Will Make Your Life Easier!

 
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Payer Contract Management 
Healthcare payer contract modeling and management with claims management to identify and overturn underpayments and denials within any HIS system and model any contract.
 
 
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Underpayments Management 
Take back the money you have earned with
our state-of-the-art revenue recovery
program.
 
 
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Denials Management
Identify and overturn wrongful denials.
Save time by cutting down appeal time by two-thirds. Invisible vs. remit denials can
only be identified by contract modeling.

 

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Contract Negotiation 
Simulate contracts with ease to compare newly proposed contract terms vs. existing contracts for win/lose analysis.
 
 
 
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Contractual Net Revenue Forecasting
Net revenue forecasting based on your
payer contract allowables vs. inaccurate historical
or bucket revenue forecasting
 
 
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RM-Validate
MS-DRG Pre-billing Risk Analysis to Uncover
Coding Compliance and Revenue Integrity
Provides a narrative description that guides coders
on the reason a claim was flagged.
 
 

The Revenue Masters Difference


Revenue Masters offers integrated healthcare payer contract modeling and management services at 20 percent of the cost of other software. Revenue Masters is the most modern, powerful, accurate and affordable healthcare contract management software, all while being the undisputed price performance leader.

Our healthcare contract management and modeling products work with any patient accounting system. Our system is cloud-based, HIPAA compliant, easy to setup, and active in as few as 30 days. It also has single and bulk appeal management features for workflow.

 

Request a Demo
or Schedule an Intro Call

 

Payer Contract Management

 

 

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Revenue Masters healthcare contract management software offers a simplified way to identify and overturn wrongful underpayments and denials. You can generate on-demand, detailed Payment Variance reports that compare the expected plan allowable to the amount that was paid by the payer — whether it was billed electronically or by paper. Keep your current claims management workflow while adding auto-calculated underpayments and denials to boost your net patient revenues.

Model any payer contract type

Revenue Masters handles all contract modeling, updates, rate tables and more. Our powerful calculators pre-calculate the expected payer reimbursement and compare that amount to the payment processed by the payer. We built our calculators to accommodate all types of complex reimbursement rates and have incorporated various qualifiers per calculator. Have a special contract calculator need? We will build it.

Additional Functionality

We also offer additional optional functionality for full claims management with the RM Reimbursement Maximizer™ for needs management, workflow assignment, custom reporting, financial forecasting and more.

 

Underpayments Management

According to MGMA, payer underpayments total an estimated 7-11% of providers' net revenues. This money is lost if it cannot be identified and captured. Know what you should get paid with combined payer contracted rates, contractual language, EDI billing data, and remit data to quickly determine if the payer paid the correct amount. No longer spend time researching claim by claim looking for underpayments or using clunky old systems. Have the peace of mind you are fully identifying and collecting on all underpayments.


 
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Denials Management

Because your contracts are all modeled in Revenue Masters software, we don’t rely on 835 remits like most healthcare contract management systems. 835 remits reflect the payer decision to pay or not to pay. Since payers use incorrect and dated rates, don’t update renegotiated rates, apply inappropriate discounts, downcode claims inappropriately or simply don’t follow their contractual agreement, the 835 remits reflect incorrect data.

With Revenue Masters you see exactly why it was denied and what to do next to successfully overturn your denials.

 

 

 

 

 

 

Contractual Net Revenue Forecasting

Gross-to-net expected reimbursement forecasting is a significant challenge many providers face today. Due to multi-channel transactions and variances within pricing and payer contracting, providers often struggle to properly manage data and determine reasonable and supportable revenue forecasting. With our customized payer calculators, we are able to net down each claim by payer for each service immediately after the claim is billed. We provide NET revenue forecasting per payer, either detailed or summarized to assist providers in tackling and managing net revenue.


 
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Contract Negotiation

Revenue Masters Cloud Contract Management system can easily simulate payer contracts and their financial impact on proposed payer rates when renegotiating contracts. We start with the existing reimbursement rates and terms, then modeling proposed contract profiles for comparison using a “copy contract function".

Our “copy contract function” tool allows users to easily create various modeling “what-if” scenarios - making it easy to compare and catch rate changes you may have otherwise missed. The system provides the ability to simulate inpatient, outpatient and physician terms to determine the full financial impact. In addition, there is the ability to create user-defined historical modeling data sets using your claim history. Use the contract comparison tool for contract negotiations to determine if the proposed contract variables will increase or decrease net patient revenues.

 

MS-DRG Pre-billing Risk Analysis

Uncover Coding Compliance and Revenue Integrity

RMValidate is a cost-effective cloud-based application to assist healthcare providers in detecting missed revenue opportunities, potential coding compliance errors, and reduce costs of incorrect original billing. RMValidate intelligently analyses pre-billed MS-DRG based on predetermined qualifiers, automatically flags claims that have a likelihood of MS-DRG validity, either missed revenue integrity opportunities or potential coding compliance concerns, and provides a narrative description that guides coders on the reason the claim was flagged.

By addressing root causes behind your coding challenges, RMValidate can improve billing practices, pinpoint educational opportunities for coders and clinical documentation improvement specialists, and accurately reflect patients’ clinical complexity. Inpatient coding is one of the biggest and most important areas when it come to a hospital’s coding compliance policy!

 

 

 

Do it Yourself or Have Revenue Masters Do it for You


Revenue Masters offers you two options when it comes to contract management and payment recovery:

Option 1. Get an RMCloud Contract Management subscription

Pay the set-up and subscription for RMCloud Contract Management for your staff to operate a state-of-the-art contract modeling/management system with full training and support by Revenue Masters.

Option 2. Hire Revenue Masters on a success-based contingency rate

Hire Revenue Masters on a success-based contingency rate to find and recover on your denials and underpayments based on a Payment Variance Audit. You will be supplied a login and mobile app with “view only” access of the RMCloud Contract Management software to have full transparency into the collections management process. We offer this as an ongoing service. You can also start with Option 1 and switch over to Option 2 moving forward at any time.

 
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Download Revenue Masters CvC — our mobile app for iOS and Android.

Use CvC (Collected vs. Collectable) to monitor your team’s payer collections progress and see all of your quick charts 24/7. Monitor payer collection performance with an eye towards achieving 100 percent payer collectability.

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Partner with us for better contract modeling that accurately assess, measures and captures all revenue owed per your contracts.