Payer Services

• Strategic Assessment & Development of programs to meet your objectives – HCSS has direct hands on experience with payer strategic assessment and design.
  
  
• Provider Reimbursement Strategies (Hospital & Physicians & Ancillary providers) - HCSS has extensive experience in the area of provider/payer contracting methods. These have included large health systems, provider groups and independent hospitals.
  
  
• Pay for Performance Programs, Risk Distribution Programs - P4P for hospital & physicians - HCSS has designed sophisticated risk and pay for performance models representing payers, providers and case management organizations.
  
  
• Actuarial & Underwriting - HCSS has experience with detailed actuarial techniques for pricing managed care products and underwriting methodologies. This includes unit price analysis, frequency projections and resulting PMPM rates for Medicare, Commercial and Medicaid business, for a competitive business operation.
  
  
• Financial Projections, Cash Flow, IBNR determination & review - HCSS can create comprehensive multiple year financial projections for analysis of strategic opportunities.
  
  
• Specific Reimbursement Programs (CPT-4 FFS, Capitation, Per Diems, DRGs, APCs) - Using actual data HCSS can prepare specific rate proposal for contracts. HCSS has experience with contracting strategies and detailed rates for each of these types of reimbursement.
  
  
• Benchmark Analysis & Norms - HCSS will review existing benchmarks and norms and access what is appropriate for your organization. HCSS can help build a comprehensive scorecard in order to determine, on an ongoing basis, how projects are tracking vs. objectives.
  
  
• Technology Assessment & Coordination of Data Warehouse Process - HCSS can determine if analysis systems and technology are at the current state of the art level for health care analysis.
  
  
• Healthcare Statistical Reporting Design - HCSS will custom design Integrated Healthcare Solutions. 
  
  
• Review & Coordination of Severity and Age/Sex Population Analysis - This includes review of methods currently employed and recommendations of state of the art approaches that will improve your analysis systems.
  
  
• ROI of case management programs & review of predictive modeling approach.