Strategic Pricing. Our pricing services focus on assisting hospitals with developing and/or refining their pricing strategy, and methodology for setting prices. Our approach is flexible and can be customized to meet specific organizational expectations. We can model complex pricing parameters and estimate future revenue impact. Key considerations include assessing market, incorporating cost, modeling payer contracts, analyzing charge structure, and consistent pricing.

Opportunity Indicators:
      • Hospitals that have low charges based on high-level market data benchmarking
      • Hospitals or health systems that have not had an outside consultants review in 3 years or more
      • Health systems that have recently acquired new hospitals

Charge Capture. Our Charge Capture approach focuses on process improvements around the documentation, posting, and reconciliation of charges for services rendered. We perform “Chart to Bill” reviews to be sure all services provided are ordered, documented and billed appropriately. Charge Capture is important because even with a 'clean' CDM hospitals may still have charge capture issues that can lead to revenue loss or compliance issues.

Opportunity indicators:
      • Drug Administration documentation issues
      • Inconsistent reporting of billing units in the pharmacy
      • Emergency Department visits shifted left of a bell curve

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Charge Description Master (CDM) Standardization. We provide a variety of services related to hospital CDM reviews; coding compliance, standardization, opportunity indicators, and other charge maintenance files.

Coding compliance involves an analysis of hospital CDM files to ensure that all codes are up-to-date and appropriate and that all billable services provided are included. Standardizations is when we assist hospitals or health systems with standardized charging practices and creating a standard CDM at the corporate level. As for other charge maintenance files; we can provide assistance with clean up of supply and pharmacy master files and verify the links between the ancillary systems and the financial system are appropriate.

Opportunity indicators:
      • Hospitals or health systems that have not had an outside consultants review in a year or more
      • Health Systems that are looking to create a Corporate Standard; this could be in preparation for rollout         of electronic medical records (EMR) or for other reasons such as the opportunity to benchmark
      • Heath Systems that are purchasing a hospital and want to incorporate the new hospital’s CDM into the         standard Single department CDM reviews for complex or highly regulated service lines
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Additional Resources

Centers for Medicare & Medicaid Services

Healthcare Financial Management Association

Modern Healthcare

The American Health Lawyers Association

Wolters Kluwer: Law & Health

Becker's Hospital Review

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