What defines contract modeling as it is performed in Epic?

• A. Taking changes to the contract or price data and comparing it against historical claims data already in the system.
• B. Taking changes to the contract against predicted future patient data.
• C. Comparing price changes against payer billed estimates for the upcoming fiscal year.
• D. Comparing changes to the actual contract against predicted future patient data.

Answer: (D)

Contract modeling in Epic evaluates how proposed changes to a contract will influence financial outcomes by applying those contract terms to forecasted patient data. The idea is to take the actual contract data—rates, discounts, exclusions, and other terms—and run scenarios using predicted future patient data such as volume, payer mix, and service utilization. This allows you to see the forward-looking impact on revenue, margins, and overall profitability, so decisions about contract changes can be informed by realistic forecasts. It’s about marrying the real contract terms with anticipated future activity to gauge financial effect.

This approach differs from scenarios that rely only on historical claims data, which are backward-looking and don’t test forward changes against current contract terms. It also differs from methods that test price changes against generic estimates without tying those changes to the actual contract terms or to projected patient data.