2023 reporting shows operating margin indexes for healthcare providers averaging -0.725% YTD, putting hospitals in a vulnerable position should a recession or a new public health emergency materialize. To address razor-thin operating margins, leaders are investing in revenue integrity to effectively curb leakage. In addition to deploying revenue-integrity-centric teams, facilitating claim audits, and implementing financial and revenue cycle management technologies, hospitals are beginning to invest in an often overlooked but extremely critical component to the success of a managed care program – contract intelligence.
At the heart of payer-provider relationships is the contract that dictates patient care reimbursement terms and conditions. Icertis is empowering leaders to rethink the role and power of the payer contract in a robust revenue integrity program.
Icertis Contract Intelligence (ICI) acts as the central nervous system for a revenue integrity program by turning payer and accountable care organization contracts into strategic advantages. The ICI platform analyzes payer contractual agreement terms and clauses and surfaces relevant insights and risks. Here are some of the ways that ICI bolsters revenue integrity initiatives:
- Improving Visibility Across Payer Contract Clauses and Terms: Impactful contractual data, such as fee schedules and reimbursement models, arms team members across the revenue cycle continuum with relevant payer data necessary to remove blind spots and siloed workstreams.
- Integrating Contract Data with Revenue Cycle Management Systems: ICI’s integration with RCM systems helps teams maximize revenue opportunities and curb unnecessary claim denials. Our configurable system integration sends payer contract data directly to your RCM system, allowing for a holistic view of payer terms and conditions.
- Arming Teams with Advanced Analytics: With advanced analytics, leaders are prepared to negotiate payer contracts and establish fair terms around the review process, payments, number of days to appeal, and other rules and policies. Leaders can make informed decisions around changes to terms and conditions, leveraging dashboards to compare across payers and understand how changes impact reimbursement, risk levels, and performance. Marrying contract data with revenue cycle practices empowers organizations and bolsters revenue integrity practices.
Healthcare providers are rethinking the role contracts may play in their revenue integrity programs and exploring contract intelligence capabilities. As you do the same, reach out and schedule a demonstration of the Icertis solution to learn more about our unique approach.
