BEST POSSIBLE PAYMENT EXPECTED FOR HEALTHCARE SERVICES

摘要

A system is disclosed that is useful by hospitals and other healthcare providers for automatically determining the best possible or maximum amount of payments a healthcare provider can lawfully expect to receive for healthcare resources which takes into account various discounts agreed upon by the healthcare provider with various private insurance companies as well as public (i.e., government) insurance providers, which administer managed healthcare plans including Medicare and Medicaid, all payments received against expected payments and a yield measurement approach for determining the providers performance at a given point in time and across various segments of its operations. In accordance with one aspect of the present invention, contracts between a healthcare provider and all private insurance companies and public insurance providers may be modeled. Various data including healthcare resources provided to patients up to a given point in time, applicable insurance company, and healthcare resource code are entered into the system. The system is able to calculate the best possible revenue that the healthcare provider can lawfully expect to receive taking into account the various discounts negotiated with the various insurance companies. Indeed, once the data is loaded, the system can provide an accurate snapshot of a healthcare provider's best possible expected revenues at any given time based upon services rendered instead of waiting until the healthcare resources have been billed out to insurance companies, patients, and third party payers. It can also provide an accurate snapshot of all payments received against those expected payments to determine yield across various segments of its operations.