|
Feature |
Benefits |
| Procedure Pricing Sets allow procedures to be priced using various pricing types |
Codes can be priced using McGraw-Hill, percent of billed, flat rates, Medicare RBRVS,
UCR, Distributed RVU dollar equivalency and/or Capitated.· Provides your organization with unlimited flexibility when entering and maintaining reimbursement schedules.· Your organization can specify whether an authorization should be required for each procedures or a range of procedures· Withhold amounts can be tracked for each procedure or range of procedures defined. |
| Contracts can differ
base on multiple factors |
Fee schedules can change
based on Health Plans, Benefit Plans, Service Location, and/or
affiliation with the network. |
| Provider contracts can
be held at multiple levels |
Contracts can be
attached at a provider level, to an entire provider group, or a
vendor.
The
“Payee Override” feature allows a vendor
to be assigned to a single contract allowing your
organization to cut checks to various vendors based upon the
contractual arrangement.
As always a default vendor can also be defined. |
| Hospital Revenue Code Sets allows users to establish reimbursement schedules for inpatient services |
Users can enter single codes or ranges of codes and assign either a percent of billed or per diem schedule of reimbursement for those services. |
| “Do Duplicate” function allows for a defined contract to be instantly replicated, modified and saved as a new Procedure Pricing Set
or HRC Set |
Saves your organization significant data entry time. With the push of a button, users can create a new set that is similar to the original set without complete re-entry of the pricing set information. |
| Capitation contracts and the Fee-For-Service equivalents can be tracked simultaneously |
Automatically calculates
Fee-For-Service equivalents on all capitated services.· Fee-For-Service equivalents are used to calculate Provider Stop loss amounts. |
