Global Pricing
The McBee Associates Global Pricing System accommodates virtually any managed care contractual relationship. Managed care "Global Pricing Contracts" are typically negotiated for major services such as cardiology and orthopedic surgery. Under global pricing, the provider establishes a fee arrangement for supplied services and participates in a risk pool fund.
McBee Associates, Inc. has a computerized system to meet the total operational requirements of these contracts. Coupled with our array of consulting services, McBee Associates successfully assists health care providers develop the internal operating procedures required to administer these contracts. Our experienced managed care team assists in all aspects of global pricing; from negotiating contractual agreements to ongoing operational considerations. The breadth and depth of our managed care expertise assures fast and effective implementation of this easy to use system.
Global Pricing System Features
Our Global Pricing System meets managed care operational needs - from billing managed care companies to paying outside physicians - while providing risk pool management functions. Its extensive and flexible reporting structure meet departmental needs continuously.
In our Global Pricing System the "rule table" organizes the specific terms of a client's managed care contracts. These rules determine the case rate reimbursement amount for all services provided to the patient. The Global Pricing System stores and updates all transactions in a comprehensive relational database that provides the data needed to calculate the profitability of all current contracts. This profitability information strengthens our clients' negotiating positions in future managerial contractual relationships.
For provider organizations the claim adjudication capabilities virtually eliminate payment discrepancies. The Global Pricing System calculates a payment amount based on the contract and produces an adjudication worksheet to submit with the claim. The worksheet helps to ensure that the provider receives the appropriate amount.
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Contract Management
The heart of Global Pricing System is the contract management module. Each contract is evaluated and a series of rules are developed to determine the proper payment amounts.
Upon admission to the hospital, the patient and physician information is entered into the module. The system generates notices to physicians, denial letters and a missing information report. Payments received and disbursements (non-risk pool payments) are automatically tracked to participating physicians and institutions.
The Global Pricing System calculates an adjudication worksheet and a bill for the managed care company. The module also prepares any related general ledger entries.
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Referral Management
The Global Pricing System manages referrals from participating physicians to non-participating physicians along with the number of consultations or approved services. The System tracks services performed and approves appropriate payments.
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Claims Processing
The claims module processes payments for all institutions and physicians. The claim processor adjudicates claims on a line-by-line basis so that specific services can be approved or rejected.
Payments can be based on various methodologies including fee schedules, flat amounts or percentage of charges. A remittance advise is produced for each check detailing coverage, denials and reasons for payment denials.
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Risk Pool Management
The disbursement of risk pool funds considers funds collected, paid, and all contractual agreements between the hospital and physicians. The Global Pricing System details all calculations and provides explanations on all risk pool disbursements. The Risk Pool Management Reports list all financial activity, providing additional explanation of calculations and disbursements to physicians.
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Management Reporting
The Global Pricing System provides reports to meet managerial and operational needs. Management reports may be customized, and end users can design reports for a unique need.
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Implementation and Training
The success of any system is directly related to the quality of the installation. To support our clients, McBee Associates provides installation assistance from turnkey solutions to specific customer related requirements, and develops internal operational requirements to administer managed care contracts. Our managed care contract expertise assures effective implementation of our Global Pricing System.
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