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.Download Brochure
Learn More About the Healthcare Contract Management Software that Will Make Your Life Easier!
Payer Contract Management
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.
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.
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.
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.
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!