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.