NAPERVILLE, Ill., April 13 /PRNewswire/ -- Concentra Preferred Systems (CPS) today introduced a new suite of Contract Diagnostic Services, a powerful assortment of tools to analyze hospital charge practices. Four service components: Contract Effectiveness, Stop-Loss Payment Evaluation, ChargeMaster Analysis and Contract Modeling provide health plans with the financial intelligence needed to improve contract negotiations and control rising healthcare costs.
Provider reimbursements and contract complexities have created the need for quantitative analysis that yields meaningful information to payors about the efficiency and effectiveness of their healthcare contracts. These new services assists health plans in evaluating provider reimbursement formulas, measuring contract profitability and modeling comparisons between network contracts.
According to Dan Marion, Vice President of Consulting Services for Concentra Preferred Systems, "Patients and their insurance companies are being subjected to hidden inflationary pricing practices by hospitals that selectively increase the list price of goods and services based on financial contribution. Hospital markups are not uniform within a department. They are increased on an itemized basis dependent on revenue after contractual adjustments have been recognized. While hospitals may consider that simply managing the business, payors need insight into the complexities of hospital pricing formulas and their financial impact."
Contract Effectiveness: compares contracted terms and/or charges with actual hospital costs and geographic benchmarks to determine net contract effectiveness in preparation for the negotiation of an initial contract or the re-negotiation of a contract renewal.
Stop-Loss Payment Evaluation: determines a usual, customary and reasonable (UCR) value of claims impacted by contract stop-loss provisions and their impact on eroding payor stop-loss protection.
ChargeMaster Analysis: evaluates a specific provider's compliance with contractually specified chargemaster protection clauses to identify outliers that exceed the contracted terms.
Contract Modeling: prospective contract simulation that enables payors to assess the impact that contract refinements will have on medical expenses, while assuring new terms can also be automated in the adjudication process.
These services are immediately available. Additional analytic services are under development.
Concentra Preferred Systems (CPS), a wholly owned subsidiary of Addison, Texas based Concentra, Inc., is the industry leader in outsourced, specialized claims cost management services. The CPS service portfolio includes: professional claims resolution, repricing, auditing, proprietary facility UCR applications and consultative services that help lower costs, increase productivity and maximize return on investment in the area of claims transaction management.
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Concentra Preferred SystemsCONTACT: Amanda Peterson, +1-630-649-5237, or Axpeterson@concentra.com ,or Gene Della Torre, +1-630-649-5045, or Gdellatorre@concentra.com , both ofConcentra Preferred Systems
