Physician practice management software for maximizing reimbursement rates from payer contracts
First Claim
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1. A software solution for assisting a healthcare provider in negotiating reimbursement rates with an insurance company payer, comprising:
- a data entry module for guided data entry via a user interface of practice and financial data specific to a particular healthcare provider practice, and said payer'"'"'s reimbursement data; and
a rate analysis module for comparing said payer'"'"'s maximum allowable rate data collected by said data entry module to Medicare locality rates and other payer reimbursement rates within any of a predefined region, state, and country.
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Abstract
A software solution for optimizing healthcare providers'"'"' profitability by benchmarking payer reimbursements to the Medicare locality rates and rates of other payers, by analyzing a payer contract'"'"'s operational language, by modeling the effect on revenue of a provider'"'"'s decision to stay in a payer'"'"'s network, by modeling the effect on revenue of a provider'"'"'s decision to adjust charge master rates, and by sampling a provider'"'"'s claims.
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17 Claims
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1. A software solution for assisting a healthcare provider in negotiating reimbursement rates with an insurance company payer, comprising:
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a data entry module for guided data entry via a user interface of practice and financial data specific to a particular healthcare provider practice, and said payer'"'"'s reimbursement data; and a rate analysis module for comparing said payer'"'"'s maximum allowable rate data collected by said data entry module to Medicare locality rates and other payer reimbursement rates within any of a predefined region, state, and country. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A web-based software solution for maximizing a healthcare provider'"'"'s revenue, comprising a data entry module that collects practice and financial data and a rate analysis module that benchmarks max payer allowable rates to Medicare locality rates and rates of other payers in the region, state, and country;
- and each module being deployed on a web-enabled back-end server so that said healthcare provider can access said web-based software solution'"'"'s main web portal with a web browser.
- View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 17)
Specification