We meet with your team to understand your managed care contracting goals and identify which reimbursement data sources you currently rely on — hospital MRFs, insurer MRFs, or other third-party sources. We define the scope of the engagement across your target markets: hospitals, physician groups, insurers & networks.
Deliverable:
Free Consultation
See Full Methodology
- Meet with your team to understand managed care contracting goals and strategy
- Learn which competitive reimbursement rate data sources are currently used — hospital MRFs, insurer MRFs, or other third-party sources
- Identify any issues
- Explain FlexPoint's proven methodology to determine current contractual rates in any sized market (large, medium, or small)
- Define the scope for a potential consulting engagement across target markets: hospitals, physician groups, insurers & networks
We review your existing data sets for accuracy, granularity, and completeness — broken out by hospital/physician group, insurer, network type, service category, and place of service. We confirm key contract provisions are captured, including reimbursement methodologies, outlier thresholds, and carve-outs.
Deliverable:
Assessment Report
See Full Methodology
- Assess whether your data sets contain the attributes required to be relevant and useful
- Evaluate how granular and current the data is
- Confirm the data is broken out by: hospital & physician group; insurer (Aetna, BCBS, Cigna, UHC); network (PPO vs. HMO vs. Exchange vs. Narrow); service category (Inpatient, Emergency, Surgery, CT/MRI, Lab/Path, Other OP); place of service (POS) codes
- Confirm key contract provisions are included: reimbursement methodologies; outlier thresholds; Inpatient (DRG Base Rate vs. Case Rate vs. Per Diem); Emergency (carve-outs for CT & MRI); Surgery (multiple-procedure discounts, e.g. 100/50/25/0); drugs and implants
We collect a small sample of current patient EOBs — the "Gold Standard" for determining a competitor's actual contractual allowed amounts — and trace them against your existing data sets and MRFs. If discrepancies surface, we collect additional EOBs until the data set is confirmed reliable.
Deliverable:
EOB Claims Analysis
(Including EOB copies stripped of PHI)
See Full Methodology
- Since 2010, FlexPoint has been the only company in the USA that recruits and compensates patients for their EOBs
- EOBs are the "Gold Standard" for determining a competitor's contractual allowed amounts
- Collect a small sample of current patient EOBs to validate whether your data sets are accurate and current
- Perform a tracing procedure to confirm whether allowed amounts per EOB agree with rates in your data sets and/or MRFs
- If validated and reliable → proceed to Analyze & Summarize. If not → collect additional EOBs to establish a reliable data set
We dissect the validated data by hospital/physician group, insurer, network, and service category — documenting reimbursement methodologies and performing a side-by-side comparative rate analysis against competitors, including year-over-year rate changes. Every calculation is fully documented for independent verification.
Deliverable:
Executive Summary & Detailed Analysis
See Full Methodology
- Dissect the data by hospital & physician group; insurer & network; service category
- Identify and document reimbursement methodologies, outlier thresholds, carve-outs, and multiple-procedure logic
- Perform a side-by-side comparative rate analysis (client vs. competitor)
- Calculate competitor year-over-year rate changes
- Summarize findings in an Executive Summary format
- Reperformance standard — all procedures and calculations performed by FlexPoint are clearly documented to enable independent verification of the reported information's accuracy
