Expected Reimbursement Optimization
Accurate expected reimbursement is the foundation that creates a ripple of success across every organization
Provider reimbursement calculations drive workflow for many stakeholders, making it a critical component to invest in for better organizational outcomes.
Maximize revenue
Strong expected reimbursement controls can increase patient estimate efficacy to improve up-front collections, highlight revenue opportunities in billing/coding, and decrease zero balance vendor spend.
Reduce cost to collect
Optimized expected reimbursement removes false variances in A/R (credit/debit), supports system automation, and reduces the need to post manual contractual adjustments.
Improve accountability
Accurate expected reimbursement serves as a shared KPI for internal teams, external team oversight, and for payer scorecards.
Expected Reimbursement Optimization & Maintenance
Provider reimbursement from payers is complicated and ever-changing with fee for service, capitation, bundled/episode-based payments, and payer reimbursement policies. Expected reimbursement is a workflow driver, data analytics source and productivity enhancer.
When maintained properly, Expected Reimbursement serves as the first line of defense for providers to ensure they are reimbursed properly.
Benefits of accurate Expected Reimbursement:
- Executive Leaders - Know with confidence what revenue you should expect and leverage this KPI as a tool for oversight of internal and external teams. A shared source of truth across an enterprise can break down silos and encourage collaboration between Revenue Cycle, Finance, Contracting, and IT teams.
- Revenue Cycle - Drive better, more accurate workflows in Epic, capture more revenue, decrease credit balances and increase staff productivity.
- Finance - Expected Reimbursement feeds the income statement, budgets and balances sheets. Accurate Expected Reimbursement improves A/R valuation, cash targets and contribution margin reports.
- Contracting - Modeling, negotiations, payer performance, impacts of payer policies and contract interpretation issues.
Our Epic-Certified team members have deep industry experience in best practices for building and maintaining the most complicated contract structures for commercial and government payers.
We offer expertise in both Physician and Hospital contract builds and offer projects to build new, clean-up existing, or maintain all contracts. We can work as a part of your existing team, alongside as a safety-net, or independently own all parts of the rate loading process.
Expected Reimbursement Optimization
RemedyIQ has a team of technical managed care experts that can identify errors in Expected Reimbursement build for negotiated commercial contracts and government programs to identify areas for refinement to ensure accurate Expected Reimbursement calculations for Finance, Revenue Cycle, and Contracting.
We have the capability to provide technical direction to Epic-IT and Contracting teams or can perform Epic build independently with our certifications, which include Resolute Hospital Billing Administration, Resolute Physician Billing Administration, Resolute Hospital Billing Expected Reimbursement Contracts Administration and Resolute Physician Billing Reimbursement Contracts.
Expected Reimbursement Maintenance
RemedyIQ has supported health systems with ongoing maintenance services to monitor contracts for performance, identify/resolve build logic issues, provide quality assurance for new contracts, track and implement fee schedule changes, and manage government factor updates.
Interim Epic Resources
RemedyIQ can support Epic-IT and Managed Care/Contracting teams with our certified Epic resources for rate loading, maintenance, or contract modeling.
Who needs Expected Reimbursement support?
- Preparing for an Epic go-live or stabilizing post go-live
- Transitioning from historicals to leveraging expected reimbursement for A/R valuation
- Experiencing staffing shortages or ticket backlogs during busy renewal periods
- Inability to build complex terms or rates with precision
- Posting high volumes of manual contractual adjustments
- Growing credit and debit WQ volumes
Meet your RemedyIQ partners
With an average of 20 years in healthcare, RemedyIQ team members bring deep expertise from provider, payer, and consulting spaces - spanning revenue cycle leadership, contract negotiation, certified technical Epic support, third-party zero balance underpayment recovery, and more.
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Eliminating $4M in False Variances: RemedyIQ's Expected Reimbursement Optimization
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