Payer Scorecard
- Provides Contracts summaries of charges, allowances, and net revenue by payer
- Includes a series of comparatives for quick scoring
- Also includes an option to receive a full-blown Contracts program
Our Process
We create a short form Payer Scorecard after drilling-down to charge and payer data to capture the statistical relationships among hospital claims and payer reimbursement. We sort fixed fee reimbursement by payer and reconcile that to individual payer contractual terms.We use this as a monthly reporting tool to measure payer performance, including the percentage of claims paid as stipulated by the Agreement, those that are partially paid, and those that are denied.
We score reimbursement by payer per procedural and revenue codes, billed amount per codes, total billed per the payer Agreement, payments received from payers, and the status of claims partially paid or denied in the aggregate and by payer.
Our Payer Scorecard provides an easy way to access results. It is available as part of our monthly summaries and BI daily financial dashboard with customized KPI’s as an option.
You can expand the Payer Scorecard to a full-blown Contracts program at any time.
Deliverables
1. A monthly Payer Scorecard by revenue billed, contractual allowances, payments, denials, percentage of claims denied, and reimbursement paid per service line, department, and revenue code
2. A drill-down to individual payer performance
3. A comparative of Remittance Advice and payments received
4. A summary of all denials in aggregate and by individual payer
5. A status report of previous payer denials that were re-submitted
6. A demographics report by payer tracking age, gender, diagnosis, and status as an existing or new patient
We routinely add new features to our Payer Scorecard and will customize yours to meet your unique or changing needs. Again, the Payer Scorecard is a short-form Contracts program that delivers timely payer metrics daily or monthly.