Case Study
A national cancer care network restores compensation peace of mind & data integrity
Challenge
The individual provider contract terms and manual nature of the client’s existing compensation management process resulted in:
– Significant payment errors of $10-100K per issue
– Declining provider trust
– Substantial internal resources depleted
– Avoidable added stressors on administrative teams
As the organization moved from a site-specific physician group model of five separate regions to a national physician group model, it was critical they reduce these errors, improve the transparency of information with their providers and create a scalable, reliable compensation calculation system that encompassed all compensation plans, RVU adjustments and variabilities at the foundation.
Solution
ProCARE implemented a centralized solution with capabilities to manage all complexities and visibility into data for all parties. The platform encompassed six compensation model types for the client including:
– Collections
– RVU Advance Practice Practitioner, CMS Charge Based Encounters
– Contract/Employed Logic and Groupings
With over 700 unique business rules, the solution was built to accommodate a wide array of complexities including contract YTD, mid-period starts (proration), retro processing by provider, team-based models, exceptions, logic, facility differences, specialty variations, and one-offs.
Approach
Powerful Rules Engine
With over 700 unique business rules, the solution was built to accommodate a wide array of complexities including contract YTD, mid-period starts (proration), retro processing by provider, team-based models, exceptions, logic, facility differences, specialty variations, and one-offs.
Analytics & Reporting
Analytics and reporting produced from the ProCARE platform include Production, Specialty Benchmarks, Visit/Encounter Statistics, Payment Percentages, Fair Market Value calculations, and internal analytics on Group/Team/ Region/Speciality breakdowns.
Role-based Access
The client’s team now has easy and immediate role-based access to critical statistics, graphs & reports across any time period on-demand.
The Right Strategy
ProCARE’s expert strategists supported significantly improved operational efficiencies, data transparency, and provider trust.
Value-Based Approach
The client’s compensation management transformation powered by ProCARE resulted in significant time savings, increase in data accuracy, dramatic reduction in errors and disputes, a streamlined physician onboarding process, and improved provider relations, satisfaction and culture.
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