Contracting

Decision Support

Decision Support provides a comprehensive contract management program, from both the provider and payer perspectives.

Integrated

Contracts

Decision Support Contracting integrates every aspect of the contract cycle, from planning through payment management. It supports a full scope of contract arrangements and pricing mechanisms, including charge-based pricing, service level pricing, capitation, risk limiters and stop-loss arrangements. The system can interface with your operational billing process to calculate expected reimbursement and adjust A/R balances at the time of billing. It supports re-bills when corrections are made to an original bill.

Our contract capabilities include:

  • Flexible service definitions including carve-outs and populations
  • Robust pricing and reimbursement modelling, including commercial and governmental payers
  • Utilization and patient mix analysis
  • Actual to expected payment variance reporting and profitability analysis
  • Underpayment analysis
  • Compliance monitoring
  • Net billing
  • Unlimited “what-if” capabilities

Decision Support addresses the main business processes of these critical stages contract management cycle:

Contract

Planning

Decision Support Contracting addresses your particular contract planning needs and business initiatives. When combined with Decision Support Costing, you can analyze cost and payment information to determine the profitability of a proposed or existing contract. During the contract planning process, Decision Support Contracting helps you analyze your business to identify what types of new contracts, covered services, and payment methodologies you should pursue. Decision Support Contracting then facilitates the development of guidelines to use in the negotiation, including break-even points, payment methods, reimbursement levels, and financial targets.

Contract

Negotiation

Decision Support Contracting supports your organization’s need to negotiate profitable contracts for both the purchase and sale of services. In combination with Decision Support Costing, you can integrate cost, quality, and payment information for the entire continuum of care to give you a solid understanding of the financial and operational implications of proposed contract terms. During the negotiation process, Decision Support Contracting gives you the power to quickly develop and analyze a wide array of contract terms, including capitation and special carve outs. With our powerful modelling tools, you can rapidly iterate through multiple proposals, offers, and counteroffers to determine what terms are best for your organization.

Contract

Compliance

Are you getting paid properly? Decision Support Contracting allows you to review the expected reimbursement against actual payment. With Decision Support Contracting, you can identify areas of operational improvement and noncompliance with negotiated contract terms, including underpayments and over-payments to other providers. Decision Support Contracting assists you in developing and implementing strategies for overcoming operational issues and negotiating payment recovery.

Key Features

Decision Support supports all your contract management needs, whether you are buying or selling services. Key features include:

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Contract Modeling

Efficient and timely development of contract terms through:

  • Easy-to-understand terminology
  • User specific, step-by-step prompting
  • Folders to organize contract payments
  • Unlimited special case payments
    • Stop loss and risk limiters
    • Carve outs
    • Lump Sum Allocations
  • Contract modelling for virtually all contract terms, including:
    • Comprehensive Discount FFS Payment Terms
    • Capitation (PMPM and Percent of Premium)
    • Carve outs
    • Global Contracts
    • Customized User Formulas
    • Medicare (PPS and APC)
    • APGs
    • Inpatient and Outpatient Medicare
    • Physician Fee Schedule (HCPCS, CPT4, etc.)
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Reporting

Powerful, flexible enterprise-wide reporting through:

  • Menu-driven and “point and click” features
  • Standard and customized reporting – defined by the user
  • User-specific report library
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Accounts Receivable Management

Consistent net revenue/payment calculations through:

  • Automated, nightly contractual allowance calculations
  • Automated interface to billing system
  • Single source calculation engine
  • Timely, automated posting of contractual allowances
  • Expected to actual reporting
  • EORs (Explanation of Reimbursement) 
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Validation

Analyze and validate risk-based assumptions through:

  • Membership trend analysis
  • Demographic changes and shifts
  • In- and out-of-network usage
  • Forecast-ed vs. actual reporting
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Billing Process Integration

Decision Support Contracting can be integrated with the existing billing processes in your information system environment. This capability provides both your operational and decision support systems with a single source for contract terms and calculations.

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  • Develop and maintain cost standards
  • Allocate actual cost, overhead, and direct, variable, and fixed costs to calculate encounters
  • Run customized “what if” scenarios across your entire organization
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  • Identify episodes, understand profitability and define costs across the care continuum
  • Analyze various episode types, such as transplant cases, re-admissions, and CMS-defined BPCI1 and CJR2 bundles
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  • Integrate all aspects of the payer contract process, including negotiation, contract planning, expected payment calculation, compliance and monitoring
  • Analyze government and non-government payer contracts
  • Conduct robust pricing and reimbursement modelling
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  • Set various budget types, including operating, flex, employee-level, and job code budgets
  • Monitor financial performance trends through embedded workflow and dashboard reporting functionalities
  • Model impact of current and future key decisions
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  • Enable enterprise-wide visibility into everyday financial, clinical and operational impact with advanced dashboards
  • Customize and schedule your desired data to easily spot trends, benchmark results and measure performance

TESTIMONIALS

What People Are Saying

Affinity Decision Support’s drill-down is definitely our favorite feature. It allows for financial management decentralization and cuts down on telephone calls to AP and payroll offices

Katja Waldman

Director of Finance,

Executive and senior level managers consistently find the drill-down functionality in Affinity Decision Support useful and valuable, in some cases, on a daily basis. Affinity Decision Support’s reporting capabilities are the best available on the market.

Masood Peracha

Consultant

We're Here To Help!

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Office

Head Office
2300 Corporate Park Drive
Suite 400
Herndon
VA 20171

Info

info@harrisaffinity.com

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Call Us

(571) 267-3928