Smaller hospitals have opted to manage payer contracts manually, but with so many ongoing changes and regulations in the complex healthcare environment, technology to improve revenue cycle has become crucial, but many hospital CFO’s wonder, at what cost? Mid to larger hospitals who have this functionality are paying six figure plus annual licensing to automatically check every claim against their contracts. They are typically using legacy software from the 90’s that doesn’t have the capability to easily adapt the contract management calculators to keep up with today’s payers increasing contract complexities.

In 2016 the adoption rate for RCM solutions is low among provider organizations, they recognize that is because of their high costs and the significant investments involved in hardware, software, and staff training.  (HIT Consultant, 2016)

Rick Bengson (President) states “The problem for many years has been that a lot of companies are using legacy applications and these old software applications are  priced extremely high. Some Hospitals have started to fear that implementing RCM software and integrated systems will increase their budget, as if losing money in denied and underpaid claims wasn’t preoccupying enough. We built an easy to set-up, affordable and enjoyable to use software service. Provider organizations don’t want to risk spending tens of thousands or hundreds of thousands of dollars paying for a software that may not even help them overturn denials and underpayments, not to mention the brain damage learning to use these dinosaur stitched together legacy applications”. Bengson further states “Providers deserve to be reimbursed every penny that they negotiated in their payer contracts. The payers are not overpaying because they have sophisticated audit systems to assure this and will take that money back. Our system is built to beat the payers and make sure every dime is paid. We even bought the domain name beat the payers dot com which goes to a fun two minute explanatory video because that’s how strong we feel about it”. This video can be viewed at www.BeatThePayer.com .

Today, it is possible to have a Contract Management Software that will bring all of the necessary tools to the table at an affordable price. With the RM Cloud Contract Management service, Revenue Masters models and maintains the provider’s payer contracts, updating the fee schedules etc… They can also assist in contract simulations to run for payer negotiations. This works for proposed contracts to run against the historicals to see if any proposed contract changes should be an increase or decrease in provider revenue. Setup is simple by just providing the payer contracts, data connections, company logo and completing a two page questionnaire. Then voila!, you have a payment variance report that identifies underpayments and denials along with the reason for the denials for you to overturn them. There is even a query and appeal function for bulk denials and a whole lot more.

Dena Bates (CEO) states “Our pure cloud platform gives us contract calculation accuracy and we can build any type of calculator. We have never had a payer contract that we can’t model for accurate calculation. With our contract management customized calculators, revenue cycle departments are now able to net down each claim per each payer for each service, immediately after the original billed claim and know how much revenue is anticipated to be recovered. That’s huge for accurate forecasting vs. historical buckets forecasting”.

RMCloud Contract ManagementTM has arrived to revolutionize Revenue Cycle Management, penetrating into enterprise and small-to-medium facilities for better volume price breaks for all. Recognizing everyone needs this tool to deal with the complicated billing within the healthcare industry and making this crucial technology reachable for all Healthcare Providers around the country.