Strategic Pricing Review
The burdens of Medicare compliance have been anything BUT paperwork reduction. Indeed, the cost of compliance activities and re-engineering processes threatens the very viability of most hospitals. While Medicare may rightly flex its muscles as the nation’s largest healthcare insurer, there is a significant volume of hospital service that’s well beyond Medicare’s reach.
For this reason, many hospitals are beginning to realize that improved revenue yield may come from looking where no one else is looking. “Price transparency” strategies offer an approach to optimizing revenue within the parameters of defensible, market sensitive pricing.
Strategic Pricing Review is CPI Experts’ solution for hospital price transparency. Strategic Pricing Review gives the hospital control over prices by adopting a best-fit price model tailored to the hospital’s unique geographic and market conditions. CPI Experts conducts a multi-variable assessment which results is a comprehensive set of detailed pricing recommendations based on high, low, and average price profiles. CPI Experts then works with your hospital to implement a defensible pricing strategy, treading lightly in high visible, market-sensitive areas while ensuring a positive impact on the hospital’s bottom line.
Mining revenue—minding the market
Revenue yield is dependent upon a hospital’s unique insurance matrix
CMS’ Standard Analytical File data is scrubbed and analyzed against your hospital’s actual usage to determine high, low and average prices in line-item detail
We present a range of options and you choose the pricing profile that’s the best fit to your organization’s business and marketing strategy
We work with you in the trenches to implement detailed recommendations in strategic areas and guarantee realization of bottom-line results
The path from recommendation to reconciliation is guided by trained professionals in partnership with hospital’s leadership to ensure the transparency of price adjustments
Strategic Pricing Review pays dividends to hospitals large and small. Whether a 25-bed rural hospital or a 600-bed regional hospital, CPI Experts will show you that the key to a healthier bottom line is the strategy you don’t see.
Charge Master Development and Standardization
Multi-hospital groups and tightly managed health networks face a unique challenge when trying to consolidate or streamline services horizontally. With different charge masters, the basic building blocks of activity between hospitals do not easily match up. In some cases, basic differences in the structuring of charge items prevent apple-to-apples comparisons across hospital lines.
Developing a standard charge master is a fundamental step in moving toward efficient multi-hospital operations. At CPI Experts, we approach the standard charge master as a “model of operations” for the group. We work with your entities to establish a single, accepted standard that supports the organization’s goals, culture, and operations.
Moving to a standard charge master does not need to be a daunting task. With the tools and expertise CPI Experts brings to the table, we help you design Medicare-compliant structures while working with department heads to ensure that each patient care area is well-supported. Next, we develop crosswalks between the old and new to assist clinical departments in implementing the new structures quickly. Finally, we accurately map all line items to CPT/HCPCS and revenue codes to ensure immediate compliance. Along the way, we evaluate structures for appropriate unbundling, clarify descriptions and remove unused charge codes.
The benefits of charge master standardization far outweigh the costs, and accrue similarly to hospitals large and small. Once implemented, a multi-hospital group is better able to operate globally—whether it’s providing patient care, negotiating managed care contracts, or arranging group purchasing.