About 23.5 million patients are served by ACO’s today.  Six million of those are Medicare beneficiaries. ACOs have grown to 744 with 433 participating in Medicare shared savings.  Payment Integrity is critical to ensure accurate pricing, billing and to drive shared savings reimbursement.

Payment, Billing and Price Integrity in One Platform

ACO savings can only be achieved through proper coordination of participating members.  What rates will you charge?  How will you handle bundling inside the ACO?  How do your ACO rates compare to Medicare’s Prospective Payment Systems?  Who’s making sure logic is in place to enforce Medicare and ACO custom rules to confirm proper billing and maximize shared savings and reimbursement? 

The Context real-time, cloud based Payment Integrity Platform facilitates all of these with the following capabilities:

  • Pricing leveraging UCR and all 16 Medicare Prospective Payment Systems to facilitate price negotiations and billing rate checks
  • UCR for Medicare gap pricing
  • Advanced Medicare, Commercial and Medicaid analytics logic to assess ACO partner payment compliance at a granular level
  • Integrated Billing Integrity checks prior to submission to maximize first submission acceptance and speed cash flow
  • Custom logic and rules can be defined based on ACO needs