Maximizing Revenue and Efficiency with FinThrive’s Contract Manager

Introduction to Contract Management

Good afternoon, everybody. We're gonna talk today about contract management and how to maximize revenue for efficiencies using our contract management tool. I'm John Wallace. I'm our solution strategy director. I've been with the company for about twenty plus years. And today, we're gonna talk about an introduction of contract manager. We're gonna talk about an overview and the contract manager modules and some of the highlights using this solution.

So from an introduction perspective, you know, when we look at this screen, it seems pretty busy, but what we wanna talk about is, you know, where does contract manager stand from a class perspective? Second highest overall for many, many years. You know, we talk about how to how does contract manager help improve your financial outcome, you know, accurate revenue, recovery, optimize contract terms, and reduce manual errors? And that's really important. By loading all the contracts, by calculating that revenue every day, we can show that utilization.

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Focus on Industry and Adoption

And, also, Finthroid is not owned by a payer contract. It was designed by revenue professionals like myself or revenue professionals like you. So think about it in really three facets of that, finance, managed care, PFS.

You know, we are fully focused and dedicated to advancing revenue management in the health care for both hospital and professional.

Also, contract management has set has set the standard industry, you know, with unparalleled accuracy using the tool. So when you think about it, by looking at it in different areas, you know, from that from from, you know, ninety eight percent accuracy, you know, across all payers, commercials, Medicare, Medicaids, TRICARE. All that logic is loaded within the tool itself. And then on top of that, the contract platform is very agnostic where it connects to. So if you're in Epic or Cerner or Meditech, from the hospital side to, you know, MP different types of platforms for hospital and professional, we can connect to any different engine from that perspective.

It's also, you know, recognized in industry. So with twenty plus years of using this solution, we today, we have over about a hundred and eighty health systems that looks about eight hundred hospitals across the country. That is a big, big chunk of business across the entire country.

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Key Benefits and Support

And then we have amazing customer experience. Many of our staff has been in your shoes, so they come from the health system like I did too many years ago. So our our experts are ready to are excited to help you with any to reach your potential.

So as we look at that from an overview point of view, think about some of the key benefits. And, again, think about the high accuracy across all different types of commercials, Blue Cross, Aetna, and Cigna's and different types of Medicare and Medicare Advantage Plans.

How do we support all that information?

So how do we support all payers? What you know, the in those niche areas? Model all payers including customized scenarios from hospitals to value based capabilities.

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User Interface and Reporting

Wide adoptions. You know, I say this again. A hundred and eighty health systems representing eight hundred hospitals or providers.

You know, it's very user interface. So think about it using it from a PFS perspective, the business office, to manage care to the finance.

Think about analytics and reporting. You know? And analytics is very key because it does come with contract management from robust analytics and reporting to define financial insights. How do you see the data calculating every day and track and train that utilization?

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Scalability and Workflow Customization

Scalability and real time processing is really important. So for every day that you drop claims, we're gonna calculate that net revenue. We can also push back expected reimbursement or net down the AR if you wanted it down net down the AR if that's what you need to do.

And then how do you customize workflow? So think about how do you wanna use it today, and how do you wanna use it tomorrow, and how do you wanna use it six months from now. You know, your organization can fit these different needs. Again, finance, managed care, PFS.

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Benefits and Outcomes

So the benefits and the outcomes. So the key part about that is the reduce, eliminate, increase, accelerate, and then improve.

I think the important part about that, when you start looking at how to reduce human error, reduce administrative burden manual work, again, getting away from spreadsheets and getting away from different types of processing that takes hours to do. Looking at denials and revenue leakage. You know, discrepancies and ensure consistency.

The the key part too that I like is is the ability to look at manual processing through automation, workflow, redundant workflows, and then uncertainty. Think about how to eliminate, you know, reimbursement delays and and then fragmentation. So I think the key part about that is, you know, by looking working smarter, not harder, is important. But, also, how do you increase revenue capture?

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Negotiate Power and Staff Productivity

Negotiate power. So think about how do you grab today's contract and model to the tomorrow's contract? And after you model those contracts for for that's been signed off by the CFO, then how do you put in operational efficiencies?

And I think that is important. Then how do you help staff productivity?

How can you track revenue from payment productivity tracking?

And then it gives you transparency and visibility.

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Accelerated Revenue and Workflow Integration

And then as you start building up to the accelerate, then how do you accelerate from reimbursement cycles, decision making, and contract, evolution.

And then the biggest thing is revenue recovery. That's what it's all about. All the stuff that I talk about is how do you identify that revenue recovery and then workflow integration. And then the key thing is how do you improve financial accuracy?

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Financial Accuracy and Cash Flow Management

Then also too, how do you bring in more cash in the door with cash flow management?

Compliance, the ability to calculate those government payers, not just the government for Medicaid, Medicare, and TRICARE, but also all those MAs, those Medicare Advantage Plans or Medicaid Advantage Plans.

Patient care through more, resource allocation and contract terms and negotiation power. So those are some really key things from the outcome and benefits from that standpoint.

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Attributes and Precise Contract Management

But one of the things I talk about from the attributes is that is that when you start looking at it is precise. You know, the ability to model contracts for forecasting and future net revenue. I think that is important. So as you're looking at your data and you're gonna and everybody has to negotiate contracts every year, How do you model those scenarios?

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Modeling and Forecasting Contracts

But the one of the key factors within contract manager is the accuracy. You know, think about all the contracts that you have today, commercial, governmental, you know, from that standpoint.

Contract manager can calculate all terms related to contractual agreements. So no matter if they're simple percentages to very complex contracts with DRG based to stop losses, to what if scenarios, to cost plus language, all that information or to even to the Anthem cost contracts is a good example that pays like Medicare but uses the Anthem's fee schedule for the hospital locality.

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Experience and Actionable Insights

And think about the experience. Right? Leverage in you know, we have leveraged the industry experience in the contract management for health organizations.

I think that is key. And then, actually, at the end of the day, though, is actionable insights. Provide customized reports and analytics to optimize revenue. So while contract manager is calculating every day expected reimbursement, expected discount, you can track and trend, analytics sits on top of that engine, and you can have KPIs, payer report cards.

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Payer Reporting and Analytics

So payer reporting, payer compliance, and payer trending. You could track that revenue. So I always say as a good example, if I sign a contract today's date, and it's I don't wanna wait for three or four months later to start finding a problem. I can start tracking and training days of payments and days outstanding based off that contract.

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Proactive Approach and Revenue Tracking

But, also, am I getting paid? Which contracts are not paying me correctly? Is it a problem in the in the ER versus outpatient surgery or a certain physician or a certain practice. I don't wanna wait months.

I can identify that right away with analytics to ensure that optimized revenue and to ensure compliance.

But, you know, when we start looking at it from a proactive approach to managing your payer contracts, you know, you can't you can't be certain if your payers are you know, payments are accurate. And one of the things that we see with our many customers that we have today is fifty percent of the payment discrepancies are due to underpayments.

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Payment Discrepancies and Revenue Loss

You know, that could be that they're they're upcoding or downcoding. They're not paying a certain certain way. We can track and trend that.

Seven hundred and fifty two thousand in lost revenue for a provider with an average payer mix. So if that is a small hospital system, that's big revenue. And if you're a big organization with multiple facilities, that seven hundred and fifty two thousand is probably gonna be two or three times that.

And then also think about two or three percent of delayed or lost revenue due to con contractual underpayments.

How do you track and trend that? That is key. So contract management, by loading all the contracts, calculating daily, we could track that utilization.

So that really brings me to the value drivers, and I think this is very important.

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Value Drivers and Payment Variances

So avoid unify unidentified payment variances, which is key by, you know, calculating expected reimbursement for all contracts in areas and not and comparing these to the actual payments. And then not it's not just the actual payments, but it's the actual discounts and any type of other transactions.

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Contract Accuracy and Negotiations

So contract management, the accuracy that we drive is plus ninety eight percent of, you know, contract accuracy across all payers. So think about that if you're a Blue Cross in California to Blue Cross in Texas or Florida or Michigan, they all pay a different structure, different methodologies compared to your Medicaids, your Medicare. All that logic is loaded within contract management. So from that point, the accuracy that we drive for both hospital and professional is that ninety eight percent or higher percentage.

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Optimizing Contract Negotiations

Optimize contract negotiations. You know? I think that is key. So remember what I was talking about, finance managed care PFS.

So modeling, you know, modeling various contract scenarios is key. So all of the epic hospitals that we have today that utilize contract modeling for negotiation is here. Right? How to grab today's contract and run a model to tomorrow's contract.

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Contract Modeling and Accuracy

And I'll talk about that in a little bit too. So we've had one client reduce negotiations from several months to less than a couple of weeks. Now we know that they can take longer, but the the the accuracy that it drives, so every time you run a model. So we had a customer of ours, a very large organization, said, John, the payers are always throwing us curve balls, helping we make a mistake.

And we're trying to throw them a curve ball, helping they make a mistake. And, basically, what we wanna do is make sure we don't strike out. So as the payer is throwing curveballs in your models, you can see every type of iteration of what they're trying to do to make sure you're getting every dollar that you're trying to negotiate. And then the biggest thing is we see about a five to ten x ROI on historical performance as using contract manager and modern analytics.

So as I build this out, I think this is very important. Right? So so how does contract manager work? First of all, we're gonna bring in first of all, I'm gonna kinda start from the right.

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Data Integration and Contract Loading

We're gonna bring in all your payments and adjustments from the patient accounting system and the contract manager. So all the data is coming in every day. We also bring claims from your claim escrowers. So eight thirty sevens, eight thirty fives, or the fifteen hundreds, payments and adjustments in the contract manager.

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Claims and Contract Loading Process

Then we're gonna load contracts back to the left. We're gonna load all your payers based off the terms and conditions, based off that payer methodology that you negotiated with. So the nice thing about contract management, we really have two tracks for this. Either we can load it and take on that labor cost, or if you wanted to do it as well, you can do that.

The majority of our customers today decide that you guys are the experts. You've been doing it the longest. You guys load them, and then we'll just audit the we'll do the final approval. And some customers will say, hey.

You get all our contracts loaded first, and then we'll take over the contract loading. So it's really a what is the best fit?

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Claims Processing and Comparison

And then in the middle part of that is that we're gonna bring in your claims from your claims scrubber. So, again, we're very agnostic. So if you're using our claims management system to, or to another system like a change or you need that different type of payer, we pull it all that host out of claim data. So every day, we calculate net revenue to the contract from the claim. And then when the payments come in, we can compare the expected versus the actual. And not only can we compare it, but we also compare it to the actual eight thirty five. So that way, we can show you total expected payment, insurance payment, and patient liability.

On the hospital side as well as the ambulatory side, we'll be breaking down by line item based off physician specialty.

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Identifying Payment Variances

So as you try to, you know, you know, avoid unidentified payment variances, contract manager, they really then become as your source of truth. So a lot of times, if a health system is gonna use their own patient accounting system as their daily workflow, they would use contract management as a source of truth.

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Understanding Trends and Exceptions

So then how do you understand trends? Right? So if I'm not being paid correctly, if if if outpatient surgery is not paying me with Revco three sixty, is it just on one payer across multiple payers? Do I need to go by look by Repco three sixty and a CPT code than not paying me? So I can drill down to that detail. And then how do you reprice identify exceptions?

I think that is very important. And then how do you flag potential at re repricing exceptions?

So, again, so contract management does become that source, that one engine to, you know, accurately calculate total revenue that is owed by all payers, commercial, governmental, and all the patients, both hospital and physician based.

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Modules and Pricing Transparency

And then as we look at so so if you think about contract manager as the engine, right, these modules that set next to it or underneath it is contract modeling, contract analytics or analyzer, reserve management and price transparency.

So contract modeling is probably one of my favorite subjects because it allows the health systems to model today's contract to tomorrow's contract. Think about that what if scenario. What if I want to import a CDM or change up a term, change up a methodology, compare different payers to utilization, or retro back and look at prior contracts that you negotiated to see how they fared out. So contract modeling is part of manager.

Contract analytics is Power BI, and that really gives you immediate insight to payer performance and and and contract performance.

You can do customized reports with analytics.

You can create custom reports. Again, finance, managed care, PFS.

Deep insight on reimbursement and payer productivity and yield is very user friendly since it's Power BI.

Reserve management. So think about it again, back to my my my kinda my three things, finance, managed care, PFS.

Finance can use reserve management under contract management to calculate month end reserves. So instead of using paid claims to drive a PCR, percent charge ratio ratio, you can use contract management to actually calculate all calculations per month in processing. So automated reserve recognition identifies, you know, lost revenue, and, also, it speeds up the time to calculate net revenue. So, again, we do utilize a step down methodology using contract manager first, then supplemental billing for concurrent coding, then PCRs and per diems.

And then lastly, the new thing that came out a year and a half ago was price transparency.

So, again, think about this. As you talk about it to look for underpayments, to do a month in reserve, and to do contract analytics and modeling, we have a reserve. We have a price transparency solution that can actually generate a machine machine readable file within contract management. It takes no IT requirements or setup.

So within that, we already have the contracts loaded within contract management. So it complied with CMS pricing rules and regulations, and it generates that cost for each item that's serviced. So so the machine readable file is is amazing fast from that perspective. So a lot of times, people are taking months to build this out.

They gotta go to an outside vendor and pay all this cost. Within contract management, it's already it already resides besides inside of that.

 

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Key Benefits of Modeling and Analytics

So as I start looking at one of the key benefits under contract management, it's really modeling. And I think this is where a lot of our customers, a lot of epic shops use this today. Out of our eight hundred hospitals, probably a hundred and twenty or five or a hundred and thirty epic hospitals use modeling. So what if scenario.

Think about what if. What if I wanna change up a structure, change up a methodology, change up any type of structure that you think of to run a model. What if? Right?

Side by side comparisons. Easy modeling comparisons. So for every model that you generate, it will show you side by side comparisons for that financial impact. Again, back what I was saying earlier, is that payer trying to throw you a curveball?

If you're expecting a six percent increase, but you only got a two percent, that's because they're putting more money in inpatient versus outpatient or different scenarios. Or a better scenario is if you have outpatient surgery with all these groupers one through nine, and if the payer says, we're gonna give you more money in groupers seven, eight, nine because those are the hot dollar procedures, sounds great on paper. But if all your volume is in one through five, there is there is the curveball they're throwing you.

So then how to start looking at it from a forecast contractual and revenue, and then think about it from an analytics perspective, pay report cards, centralized contract repository profitability.

Those things are key. So modeling is built with inside contract management, so it allows you all of that structure. Again, what does your data say that the contract sells differently?

And then then analytics is that hood of the engine. Right? So think about that intelligence, diagnose denials. Look at contract terms and errors and try to track that information.

Think about KPIs, high level high level, high level, compare actuals to targets. Right? Think about that KPI from executive levels to different different method method method method methodologies.

Payer report cards, payer compliance, payer trending. Drill down to the end of the payers. Find that utilization across the core data. Customize dashboards.

Another thing that we have is Medicare benchmarking within contract analyzer. So think about it. If I wanna say, how is my Blue Cross for utilization of a year, and how does Medicare benchmark to that? So contract analyzer will show you the Medicare benchmarking.

That is so phenomenally amazing because you don't have to run a model. Analytics will show you that information. So contract analyzer sets on that engine to where you can create custom reports for finance to managed care to PFS, and then you can track and train that utilization to create custom reports.

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Prospective Episode Manager and Price Transparency

Finance, for the finance.

We do have a prospective episode manager that if you said, you know, how do I look at a bundle or a transplant where contract manager is a fee for service engine? Our episode our PEM perspective episode manager calculates those bundles.

Right? So how do you how do you track a a transplant from a pretransplant to a transplant to a post or specific or specific for or a certain bundle? So all that is different offerings.

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Success Stories and Highlights

And then, you know, the price transparency from CMS compliance, reimbursement visibility, and how to maximize revenue. So that is very key from that key component of that back to create that machine readable file.

And then some of the highlights that I wanna talk about. We've had some people identify underpayment six to eight million consistently year over year. We had one health system identify increased collections over five hundred over five hundred million dollars over ten years. And then one customer that I know very well reduced their negotiations less than three weeks that I was taking them several months to do.

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Closing Remarks

So if you wanna learn more, you know, I'm the guy that does this. This. So John Wallace, if if you need more information, please, let me know. I'll be glad to give you a demonstration.

And I thank you very much, and have a blessed day.

Thank you so much, guys.