Payer Mix Analyzer

Understand how your payer mix impacts revenue

Healthcare revenue performance depends heavily on payer mix—the proportion of patients covered by Medicare, Medicaid, commercial insurers, and self-pay.

Monthly close cycle: Automatically runs on the 5th business day after month-end close
Quarterly deep dive: Enhanced analysis triggered before quarterly board reporting
Total patient encounters by payer class
Gross and net revenue by payer with period-over-period comparisons

Payer Mix Analysis

Monthly report • vs budget variance

-$1.2M
Commercial
42%budget 48%
Medicare
34%
Medicaid
18%
Self-Pay
6%
Revenue Impact
Mix shift-$840K
Rate variance-$360K
Volume+$180K
Key Drivers
Commercial declineMedicaid growthContract review

Built for finance teams
who demand accuracy

Healthcare revenue performance depends heavily on payer mix—the proportion of patients covered by Medicare, Medicaid, commercial insurers, and self-pay.

CFOs and VP of Finance responsible for revenue performance

Portfolio-wide oversight

Revenue Cycle Directors managing payer relationships and collections

Strategic oversight & escalation

Financial Analysts preparing monthly close and variance reports

Data-driven insights

Managed Care Directors negotiating payer contracts

Strategic oversight & escalation

From alert to action in minutes

The objective of this agent is to improve revenue attribution and financial planning accuracy.

Step 1

The Trigger

You define when the agent should activate. When conditions are met, it starts working automatically.

  • Monthly close cycle: Automatically runs on the 5th business day after month-end close
  • Quarterly deep dive: Enhanced analysis triggered before quarterly board reporting
  • Ad hoc request: Finance leadership requests analysis when revenue misses expectations
Step 2

360° View

The agent opens a tailored dashboard consolidating data from all your systems.

  • Total patient encounters by payer class (Medicare, Medicaid, Commercial, Self-Pay, Workers' Comp)
  • Gross and net revenue by payer with period-over-period comparisons
  • Average reimbursement rate per encounter or per RVU (Relative Value Unit) by payer
Step 3

Automated Analysis

The agent follows a structured analysis flow, combining checks with exploratory reasoning.

  • Volume variance calculation: Compares actual patient encounters to budget, holding payer mix and rates constant. Quantifies how much revenue variance is attributable to volume alone.
  • Mix variance calculation: Holds volume and rates constant while applying actual payer mix percentages. Isolates the revenue impact of serving more or fewer patients from each payer class.
  • Rate variance calculation: Compares actual reimbursement rates to budgeted rates by payer. Identifies payers where rates improved or declined.
Step 4

Actionable Output

After analysis, the agent creates a human-friendly report with everything your team needs.

  • Executive summary: One-paragraph overview of revenue performance and key drivers
  • Variance bridge: Quantified breakdown showing volume, mix, and rate contributions to revenue variance (e.g., "Payer mix shift reduced revenue by $340K, offset by $180K favorable rate variance")
  • Payer-level detail: Table showing each payer's volume, rate, and collection changes with dollar impact
Step 5

Delivery

Reports are sent automatically via email or accessed directly in Veezoo.

Key benefits for finance teams

Concrete, measurable value for your team from day one

Deep Analysis

Time saved: Before: 2-3 days manually pulling data from multiple systems and building variance bridges

Now: Complete analysis delivered automatically within hours of month-end close.

Lower Risk

Revenue visibility: Understand exactly how much revenue moved due to mix shifts versus rate changes—typically revealing 1-3% of revenue at risk from unfavorable mix trends.

Key Benefit

Contract negotiation leverage: Enter payer contract discussions with clear data on reimbursement trends and volume patterns.

Up and runningin production in weeks

To deploy this Agent, you connect Veezoo to your existing Data Warehouse, typically containing data from:

Revenue Cycle Management (RCM) system: Patient encounters, charges, payments, adjustments, and denials by payer (e.g., Epic, Cerner, or standalone RCM)
Financial system / General Ledger: Budget figures, net revenue, and contractual adjustments
Payer contract repository: Contracted rates and fee schedules by payer (can be spreadsheet-based)
EHR data: Case Mix Index, service line assignments, and encounter details
Medicare
Medicaid
Commercial
Self-Pay
Payer
Revenue

Ready to explore Payer Mix Analyzer?

Fully customizable to your workflows, data sources, and business requirements.

Typical initial implementation in weeks, not months.