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Your Problem

Chargemaster pricing that is inconsistent with your payer and market contracts can negatively impact your reimbursement and volume. Additionally, many facilities implement yearly blanket pricing increases without considering the organization's current financial goals and pricing position.

Our Solution

The collective industry expertise of our staff, enable MedCom to provide your organization with a well-balanced, defensible pricing strategy that carefully considers financial objectives, market position, and regulatory guidelines. Performing a comprehensive pricing review can not only benefit the bottom line, it can also help your organization achieve increased leverage with managed care payers and increased patient satisfaction.

Strategy Development

Our consultants will work closely with your financial management team to customize a pricing strategy that meets the goals of your organization and aligns with current regulatory guidelines. Key strategic considerations include:

  • Organizational Goals

    Define gross and net revenue objectives for your organization.

  • Market Position

    Evaluate your facility's current and desired market position relative to competitors.

  • Payer Contract Stipulations

    Incorporate contractual and budgetary considerations, such as percent of charge and gross charge increase caps.

  • Service and Supply Costs

    Determine how costs align with charges.

  • Flag Opportunity for Renegotiation

    Identify payor contract rates or terms that hold opportunity for renegotiation.

Defensibility Auditing

Once a strategy is determined, MedCom's clinical and financial consultants will execute the strategy on a line-by-line basis. This comprehensive review incorporates the following key components:

  • Reimbursement Audit

    to ensure prices meet fixed-fee thresholds.

  • Linking

    Ensure price uniformity for coded procedures across the health system.

  • Tiering

    Validate price relationships for similar procedures by acuity and resource utilization with a line-by-line clinical review.

  • Modifier Audits

    Adjust pricing to account for price impacting modifiers.

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Customized Solutions

Throughout the analysis process, sensitivity analyses will depict how various pricing scenarios affect your bottom line. MedCom applies a customized net revenue model based on your facility's current reimbursement structure.

This allows our analysts to evaluate net revenue changes related to price movement down to the individual line item.

We’d love to hear from you

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