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Provider Network and Contracting Management |
| Reden & Anders provides detailed financial analytics for provider contracts including facility, physician, and ancillary services. Many Medicare health plans utilize the fee-for-service Medicare provider contract as the basis for their own provider contracts. These provider contracts often contain complex structures that can be difficult to analyze. We have the tools and expertise to effectively investigate these complex contracts and provide meaningful analyses. |
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Services & Tools:
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ASC Calculator
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The Reden & Anders ASC Calculator translates the various reimbursement allowances by the Medicare ambulatory surgical category (ASC) groupings into a single average reimbursement allowance per outpatient surgical encounter. |
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Excess-of-Loss Rating Model
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The Reden & Anders Excess-of-Loss Rating Models develop excess-of-loss premium rates for various populations with two tools; the Hospital Model calculates rates for hospital-only and global coverages and the Physician Model calculates rates for professional coverages. |
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Ingenix Health Technology Pipeline
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This management tool is one of the few publicly available sources of information that contains both a comprehensive identification of developing health technologies as well as a projected cost impact and suggestions for operational adjustments to minimize costs. It combines the clinical information in the pipeline with financial forecasts so you can anticipate your future medical expenses and plan accordingly. |
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Inpatient Charge Profile
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The Reden & Anders Inpatient Charge Profile, developed from the Centers for Medicare & Medicaid Services (CMS) MEDPAR data, provides information on billed charge levels by Major Diagnostic Categories (MDC) codes. Historical information is provided for multiple calendar years, with annual trends conveniently summarized. |
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Medicare Advantage Provider Contracting
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Reden & Anders can assist you with Medicare Advantage provider contracting. With tools specifically developed to model reimbursement as a percent of Medicare reimbursement, Reden & Anders can help you measure the affect of changing provider contracts.
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Medicare Inpatient Repricer
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Using the Medicare Inpatient Repricer (MIR), Reden & Anders can re-adjudicate DRG-based inpatient claims to determine exactly what CMS would have paid for them—for every hospital at any recent date. The MIR can also project them through the fiscal year. |
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Physician Charge Forecaster
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The Reden & Anders Physician Charge Forecaster, developed from the Medicare 5% Sample data, provides information on billed charge trends for specific codes and groupings of CPT codes for 35 specialties. |
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Provider Contracting Analysis
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Reden & Anders experts can assist you with provider profiling and credentialing in conjunction with selective contracting of providers from networks to give your enrollees access to high quality treatment at competitive costs. |
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Trend Analysis
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Reden & Anders assists you with both measuring historical trends as well as forecasting trends. Our actuaries take great care to identify the drivers of historical trends, including information on demographic mix and utilization and unit costs by service categories. Reden & Anders can implement all of the Ingenix products, including the Ingenix Health Technology Pipeline and predictive modeling techniques, to identify emerging technologies and the actuarial affect on costs. |
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Questions?
To discuss how we can help your organization, please contact us:
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info@reden-anders.com or
(800) 765-6042 |
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