Learn How to use AllPayor for Modeling EAPG Contracts & Price Transparency
Healthcare advancements in treatments and procedures are less invasive and complex, while the reimbursement rate structure for most insurance payors has shifted from percentages and case rates to APC and EAPG logic. Focusing on EAPGs, the layers of calculation logic prevent most providers from reviewing reimbursement or modeling contract proposals, leaving dollars on the table and without impact analysis data.

CMS is Issuing a Proposed Rule to Increase Penalties for Larger Hospitals Violating Disclosure Requirements. To boost compliance, CMS has proposed increasing the minimum fine for price transparency violations to up to $2 million per year. Hospitals with more than 30 beds in violation of the rule would pay $10 per day for each bed, up to $5,500 per day. Hospitals with 30 beds or fewer would continue to pay up to $300 per day. This would make the annual penalty at least $109,500, or as high as $2 million a year for large hospitals that fail to make prices public. 

Next Webinar on Thursday, March 17, 2022

@ 1:00 PM CST 

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What You Will Learn On This Free Webinar:
The AllPayor System from MC AnalyTXs can provide modeling analysis, reimbursement review, and pricing information unique to the organization’s contract with a payor and specific to the EAPG versions. Any deviations from standard logic, such packaging or consolidation, and allowing for specific carve-outs, most notably COVID-19 related fee schedule services, are factored into the setup for your organization’s contracts by AllPayor Client Support Services. AllPayor provides organizations with the ability to model EAPG contracts to review upcoming changes in weights, consolidation, packaging, and grouping logic. This information is unique to your organization and its contracts and is solely used to help you gain control of your EAPG based contracts.  

Calculate the Plan Benefit expected from all Payors and compare that expected benefit to the actual payment(s) received. Identify all Payment Differences and facilitate adjudication follow-up. Collect every dollar due.
Compare Profitability by Payor, by Facility, by Product Line, by Physician … the possibilities are endless. From any report, drill down to the individual claim level detail. Identify and capitalize on your competitive strengths - eliminate competitive weaknesses.
Confidently record your monthly Contractual Allowance for unbilled and in-house charges. This unique function eliminates spreadsheets, ties directly to your filed claim population, and creates a formal structure. Exceed Sarbanes-Oxley standards.
Create instant Models using "what-if" clones of your existing contracts applied directly to your claim data. Instantly evaluate contract proposals against your unique case mix. Quantify the effect of counter-offers real-time during the negotiating session. Negotiate the best payor contract terms.

Create Patient Pricing Quotes in response to patient inquiries...using your hospital's specific claim, payment, and contract data. Produce a procedure specific quote which includes all of your usual and customary charges for such visits. Tell the patient in less than a minute what the out-of-pocket liability will be and collect the deposit on admission.

Ensure contract modeling capabilities for any payor contract around - United, Aetna, Blue Cross, Humana, CIGNA, Medicare, Medicaid or any other payor. Then make it available to all hospitals for a reasonable, all-inclusive monthly fee. The final result is simply the best, most well designed, robust, user-friendly contract management and claim modeling software available today...period. 

Find out why Rush Health Systems and University of Mississippi have recently chosen MC AnalyTXs AllPayor as their solution for Pricing Transparency, Contract Modeling/Patient Pricing/Denial Management & Underpayment Review. 
Our Clients Trust Us
Here are a few things about our service, character, results, perseverance, and follow-up that some of our clients have to say about MC AnalyTXs:

MC AnalyTXs will go above and beyond for you...
We have been a MC AnalyTXs (MCA) user for six years or so. I have nothing but great things to say about the system and service. First and foremost, the system is quite user friendly. That was one of our main concerns when looking for a system to enhance our revenue cycle for underpayments and contract modeling. It is menu driven so getting to a specific area is quite easy.
As with any other health system, we have to be watchdogs for incorrect claim payments. As we load and maintain our contracts in this system, we can easily review reimbursement from payers and tell when something is paid incorrectly. With a staff of two, we are approaching $3M in recoveries this fiscal year. That is real money to the bottom line! The real plus that made our organization choose MCA is the capability of their tool to calculate EAPG and APR DRG's. This assists us in reviewing Wellmark and IL Public Aid claim payments.
The staff is extremely knowledgeable and helpful. Many of the MCA employees have worked for providers in the past and understand the challenge of receiving the correct reimbursement from payers. MC AnalyTXs will go above and beyond for you. It is a smaller company that helps us produce big results!

Bob Wilcox - Satisfied Client
I recommend them highly...
"The software and staff support provided by MC AnalyTXs has been very effective in providing Gerald Champion Regional Medical Center the capability to model our payer contracts, calculate the expected reimbursement on our claims, and identify short payments. I recommend them highly!"
Pete S. - Satisfied Client
Their tools are exceptional...
"Their tools are exceptional. However, more importantly, their staff and leadership team have the vision, integrity, and customer focus that provides a level of trust that all of us hope for in a relationship with our vendor partners."
Kirk C. - Satisfied Client
Truly the best...
"Truly the best, most thorough, detail oriented, persistent (at dogging the payers), retrospective Medicare audit recovery firms I've ever experienced. We refer to them at our hospital as "The Anti-RAC". Given the government's declared war on providers, we need MCAnalyTXs on our side!"
Rudy C. - Satisfied Client
Data Protection is our highest priority.
AnalyTXs AllPayor® is web-based. This ASP model system allows desktop access by every client designated hospital employee. Access privileges are employee specific, controlled by the client and are easily modified. Data Acquisition is simply designed to be a by-product of routine hospital operations and does not require the use of valuable hospital Information System resources. Most of all, rock-solid reliability and top-level security for your claim management & contract modeling needs.

Our Design Goals Were Simple
Begin by creating a system that is functionally rock-solid, fast, accurate, technologically advanced and easy to use. Then make it accessible through the web with no user capital outlay. For users, make it intuitive, totally point and click. Build it in Oracle - the best database in the world - and keep it locked-down HIPAA secure. 
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