MDoffice’s contract gives PCPs and specialists the tools to accept full-risk responsibility in a managed care environment. Scheduling, billing and receivables integrate seamlessly with HMO and PPO contracts. Tracking fees, contractuals, co-payments, deductibles and capitation by plan and provider, MDoffice allows you to study a plan’s performance to see if a managed care provider is paying you enough.

MDoffice’s Contract Management function helps you review contract terms including covered and non-covered services as well as services requiring authorization, second opinions, and other prerequisites. The system can help your office or hospital create managed care bills, manage payment reconciliation and perform complex calculations. Without these sophisticated tools, you can easily lose money you should be receiving under managed care contracts.

Detailed contact analysis gives you profitability and use reports by plan, provider, patient and procedure. This analysis tells you the plans that are the most profitable for your practice. You can track and analyze each plan with as much detail as you want. By using unlimited fee schedules, it’s easy to make your fee agreements comply with managed care organizations and bill Medicare the proper fee for its payments.

MDoffice tracks referrals requiring advance approval, alerting you when permissions are required. It tells you if the authorization is pending, accepted, or denied and will warn you of pending lifetime, annual or frequency limits. It can prevent claims for unauthorized services and automatically links permissions and referral numbers with scheduling, visits and amounts.

MDoffice’s contract management lets you easily review contract terms before you render service, including services covered and not covered and services requiring authorization, second opinions, or other prerequisites. You know when a procedure is covered or not. A managed care contract can include any combination of approved physicians, approved specialists, and allowed procedure and diagnostic codes. You can define limits of dollar amounts or number of visits. Practice-defined criteria spell out advanced authorization that is required, recommended, or not required.

To help you monitor your success on managed care contracts, MDoffice will show you actual charges for capitated patients and what you would have received by charge a fee for service.

Tracking the incredible diversity of managed care plans is not easy. MDoffice can automatically generate and verify managed care co-payments, calculating and posting co-pays when charges are entered into an account. If you’re a PCP, you can generate co-pays by plan; if you’re a specialist, you can calculate the co-pay by procedure or special fee.

Referral Management
Capitation Management