PMMC Prospective Contract Modeling.

Save time, gain confidence, and understand the impact on the bottom line when negotiating new payer contracts with healthcare contract modeling. Contract modeling services allow your organization to model thousands of various reimbursement combinations to understand the impact of the proposed payer contractual terms on your bottom line.

Learn more about payment models / contract modeling today!

Modeling & Analysis

With PMMC’s SIMULATOR modules, there is the ability to easily simulate payer contracts and their financial impact. PMMC recommends starting with the existing reimbursement rates and terms. Then modeling proposed contract profiles for comparison using a copy contract function. This allows users to easily create various modeling / model scenarios. The system provides the ability to simulate inpatient, outpatient and physician terms to determine the full financial impact. In addition, there is the ability to create user-defined historical modeling data-sets using your claim history.

Reporting & Analysis

Simulation results can be viewed online or be printed, and sorted by payor/insurance codes.  Built-in reports provide quick analysis of the effective discount rates, stop-loss, add-on reimbursable items and other factors that contribute to the overall profitability using specialized simulation reports. Modeling the impact of proposed reimbursement terms using the client's historical data ensures accurate projections of utilization and charge patterns. Users can easily project effective discount rates for true side-by-side comparison between various contract terms including Medicare and the current contractual rates and terms. 

Contract Modeling Support Services

For hospitals with limited resources to model prospective contractual agreements, PMMC offers a Payer Negotiation Support Service. This value-added support program ranges from contract modeling, to data analysis, to face-to-face payor negotiation. Frequently PMMC is called on to provide “background” analysis and modeling assistance to hospital negotiators. PMMC’s knowledge of managed care markets can create substantial improvements in rates, terms, and other conditions to achieve a balanced win/win contract. This program also allows clients the ability to access experienced contract modeling / negotiating staff that can provide accurate analysis in an efficient fashion during the negotiation process.