Chandler Barron is president of Parathon, which provides hospitals and health systems tools to collect all the revenue they have earned. Read Chandler Barron's full executive profile here.
In healthcare, predicting the outcome of a given contract with a health insurer or other third-party payer is vastly more complicated than predicting how a contract will play out in other industries. It can be difficult for even the most seasoned healthcare executives to accurately evaluate how a contract being negotiated will perform, or even how a current contract is performing, compared to the expected revenue.
Complex contractual terms, conditions and provisions can have a dramatic effect on revenue because so many variables go into constructing a claim and documenting care. Often, hospitals spend excessive resources to collect what they are owed from their existing payer contracts, leaving fewer resources and even less time to evaluate contract proposals and how they will affect future revenue.
Those same claims are then modified to reflect the specific changes to the service code and re-adjudicated against the current contract to determine where an increase or decrease in the contractual expected reimbursement may result.The best partners offer modeling based on price sensitivity that can determine how hospital prices affect ultimate reimbursement for services. Knowledgeable revenue cycle executives know price increases don’t always result in higher revenue.
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