MDoffice's contract management provides primary care physicians and specialists with the tools to take on full-risk responsibility within managed care environments. MDoffice's HMO and PPO contracts integrate seamlessly with scheduling, billing and receivables. It maintains fees, contractuals, copayments, deductibles and capitation by plan and by provider and allows physicians to analyze a plan’s performance and determine whether they’re being paid sufficiently in their managed care contracts. 

Contract Management also provides the ability to review contract terms prior to services. This includes the identification of covered and non-covered services as well as services requiring pre-authorization, second opinions, or any other prerequisites. Also provided with MDoffice is new and expanded capabilities to help your organization create managed care bills, manage payment reconciliation and perform complex calculations. Without these sophisticated tools, healthcare providers can easily lose revenue opportunities they are entitled to under managed care contracts. 

MDoffice's contract management provides the operational and management tools that are crucial to the successful administration of managed care agreements.

Detailed contract analysis provides profitability and utilization reports by plan, provider, patient and procedure. This analysis highlights which plans are the most profitable for your practice. You can track and analyze each managed care plan with as much detail as needed. Unlimited fee schedules make it easy to comply with your fee agreements with managed care organizations and bill the proper fee for Medicare patients.

MDoffice automatically checks the managed contract and issues a warning when contract limits are exceeded. The practice can define lifetime, annual, and frequency limits for each contract. It also tracks those referrals that require pre-authorization, alerts the user when an authorization is required, and presents the authorization as accepted, pending or denied. 

Using an unlimited number of contracts and fee schedules, MDoffice's contracts effectively handles any type of managed care arrangement. It can prevent claims from being submitted for non-authorized services and automatically links authorization and referral numbers with claims and also links scheduling to the number of authorized visits or amounts. 

MDoffice's helps control managed care relationships and negotiated contractual fees with insurance payors. MDoffice aids in monitoring, measuring and analyzing the profitability of each individual managed care contract. It lets office staff address the additional requirements of participating in managed care without disrupting the way the practice is managed.

Flexibility in defining plan contracts.

With MDoffice's contract management, contract terms can be easily reviewed prior to services being rendered. This includes the identification of covered and non-covered services as well as services requiring pre-authorization, second opinions, or any other prerequisites. For each procedure, you can track whether it is covered or not. 

Contracts can include approved physicians, approved physicians by specialty, approved facilities, allowed procedure codes, allowed diagnostic codes, or any combination of these. You can also define limits based on dollar amount or number of visits to be set up for each plan’s managed services. Pre-authorization for services may be defined as required, recommended or not required depending on practice-defined criteria.

MDoffice provides the operational and management tools that are crucial to the successful administration of managed care agreements. Without these tools, healthcare providers can easily lose revenue opportunities they are entitled to under managed care contracts. 

How are you doing on managed care contracts? 
MDoffice's managed care reports show actual services for charges for capitated patients (and what you would have received on a fee for service basis) to help you monitor your success on these contracts. Use actual fee data to negotiate accurate and defensible managed care fee schedules.

Copayment management.

Copay or nopay? Keeping track of the incredible diversity of plans is no easy task. MDoffice can help by allowing you to calculate copays automatically. Copays due are automatically posted when you enter charges on an account. 

Copayments in MDoffice can be automatically generated and verified for patients covered by managed care plans. PCPs can generate copays by plan, while specialists can additionally have the copay generated by procedure or special fee. 

Visit copay information can be added automatically when entering charges to record payments made at the time of service. Note that this allows posting of payments automatically to specific charges -- no need to add to the patient's credit balance for later allocation to a specific line item. 

Copays due come directly from the patient's primary insurance plan and keep track of required (contracted) patient copayment amounts at the time of service. Copays also serves as an information field to remind the staff that that there is a visit payment due for this patient.

Capitation management.

When entering charges for capitated plans, MDoffice allows you to post procedures for services rendered and automatically record a zero charge for patients covered by capitated plan. This approach allows for your accounts receivables to be more accurate. 

By having every fee entered at the contracted fee and letting MDoffice automatically writeoff the difference between the copay and contracted fee, you're able to compare what was written off against what has been actually paid in capitation and incentive payments. MDoffice easily allows for automatic capitation adjustments on normal fees for subsequent analysis versus capitation.

How are you doing on managed care contracts? 
MDoffice's managed care reports show actual services for charges for capitated patients and what you would have received on a fee for service basis to help you monitor your success on these contracts. Detailed reports show managed care related activity for a specific patient, provider and/or plan.

Referral Management
Capitation Management