Managing medical cost spend via robust reimbursement system analysis
We assist commercial health payers / insurers in implementing and maintaining reimbursement systems. Our comprehensive approach to reimbursement methods includes the use of experienced consultants, clinicians and proprietary software to model and manage inpatient, outpatient and professional reimbursements.
Our payer financial strategy consulting services include:
- Designing, evaluating and enhancing new and existing provider reimbursement systems.
- Benchmarking and modeling payment methods for Inpatient, Outpatient and Physician Fee Schedules
- Billing and payment contract policy development
- Providing claims processor education via custom designed training plans
- Developing a thorough systems audit and workflow review to identify areas of vulnerability
- Delivering provider contracting support and education
Our comprehensive range-of-services have been successfully employed by payers/insurers nationwide. We can help assess and implement a new payment system or improve the one you already use. Our consultants use a combination of established methodologies and automated analysis tools to assess the impact of payment systems. We provide a full spectrum of financial planning and utilize tools and methodologies developed by years of experience.
Common themes emerge when we assess various payment methods across government and commercial payers/insurers. Using the industry standard as a benchmark, CGI examines your plan’s historical claims data to model against for your utilization. This yields details on how well providers are coding for your system, what your utilization will look like moving forward and how your payments compare to industry standards. CGI also reviews areas affected by the new reimbursement methodology and where you need to differentiate and accommodate your business that a new payment system does not support.
Information systems and data warehouses are affected when establishing a new payment system or enhancing an existing one. We ensures continuity with your existing systems and identifies areas for enhancement due to new payment method specifics. If system enhancements are needed, we can guide your staff or provide staff augmentation to enable the payment system parameters to become reality.
Read more in our brochure.