We model payer contracts within turnkey, user-friendly cloud software at a fraction of the competitors' prices.
Boost your net patient revenue by identifying and overturning underpayments and wrongful healthcare denials and underpayments.
Learn More About the Healthcare Contract Management Software that Will Make Your Life Easier
Payer Contract Management
Revenue Masters payer contract management software offers a simplified way to identify and overturn wrongful underpayments and denials. You generate a detailed Payment Variance report that compares the expected plan allowable to the amount that was paid by the payer — whether it was billed electronically or by paper. Keep your current claims management workflow while adding auto-calculated underpayments and denials to boost your net patient revenues.
Model any payer contract type
Revenue Masters handles all contract modeling, updates, rate tables and more. Our powerful calculators’ pre-calculate the expected payer reimbursement and compare that amount to the payment processed by the payer. We built our calculators to accommodate all types of complex reimbursement rates and have incorporated various qualifiers per calculator. Have a special contract calculator need? We will build it.
We also offer additional optional functionality for full claims management with the RM Reimbursement Accelerator™ for needs management, workflow assignment, custom reporting, financial forecasting and more.
Know what you should get paid with combined payer contracted rates, contractual language, EDI billing data, and remit data to quickly determine if the payer paid the correct amount.
Fast & easy to use
No longer spend time researching claim by claim looking for underpayments or using clunky old systems.
Have the peace of mind you are fully identifying and collecting on all underpayments.
Because your contracts are all modeled in Revenue Masters, we don’t rely on 835 remits like most denial management systems. 835 remits reflect the payer decision to pay or not to pay. Since payers use incorrect and dated rates, don’t update renegotiated rates, apply inappropriate discounts, downcode claims inappropriately or simply don’t follow their contractual agreement, the 835 remits reflect incorrect data. With Revenue Masters you see exactly why it was denied and what to do next to successfully overturn your denials.
Contractual Net Revenue Forecasting
Gross-to-net expected reimbursement forecasting is a significant challenge many providers face today. Due to multi-channel transactions and variances within pricing and payer contracting, providers often struggle to properly manage data and determine reasonable and supportable revenue forecasting. With our customized payer calculators, we are able to net down each claim by payer for each service immediately after the claim is billed. We provide NET revenue forecasting per payer, either detailed and summarized to assist providers in tackling and managing net revenue.
Make Better Decisions. RMCloud Contract Management™ can easily simulate payor contracts and their financial impact on proposed payer rates when renegotiating contracts. We start with the existing reimbursement rates and terms. Then modeling proposed contract profiles for comparison using a “copy contract function.” This allows users to easily create various modeling scenarios. The system provides the ability to simulate inpatient, outpatient and physician terms to determine the full financial impact. In addition, there is the ability to create user-defined historical modeling data sets using your claim history. Use the contract comparison tool for contract negotiations to determine if the proposed contract variables will increase or decrease net patient revenues.
Copy Contract Function
Allows you to copy existing reimbursement rates and terms then compare to new or revised contracts - making it easy to compare and catch rate changes you may have otherwise missed.
Integrated process for modeling prospective payor contracts to improving future reimbursements and accurately assessing, measuring and capturing all revenue contractually owed with current contracts.
Rate and Scenarios Modeling
Improve overall financial performance of your organization by being prepared for contract negotiations.
MS-DRG Pre-billing Risk Analysis
RMValidate is a cost-effective cloud-based application to assist healthcare providers in detecting missed revenue opportunities, potential coding compliance errors, and reduce costs of incorrect original billing. RMValidate intelligently analyses pre-billed MS-DRG based on predetermined qualifiers, automatically flags claims that have a likelihood of MS-DRG validity, either missed revenue integrity opportunities or potential coding compliance concerns, and provides a narrative description that guides coders on the reason the claim was flagged.
Option 1. Get an RMCloud Contract Management Subscription
Pay the set-up and subscription for RMCloud Contract Management for your staff to operate a state-of-the-art contract modeling/management system with full training and support by Revenue Masters.
Option 2. Hire Revenue Masters on a success-based contingency rate
Hire Revenue Masters on a success-based contingency rate to find and recover on your denials and underpayments based on a Payment Variance Audit. You will be supplied a login and mobile app with “view only” access of the RMCloud Contract Management software to have full transparency into the collections management process. We offer this as an ongoing service. You can also start with Option 1 and switch over to Option 2 moving forward at any time.
Payer Contract Management Guide
Underpayment and Wrongful Denial