Man using tablet pc against medical interface on xray-1

Streamline Charges, Increase Reimbursement 

Profit margins are shrinking for hospitals across the country. Bundled payment structures are rising, making it difficult to determine if reimbursement is accurate. Healthcare providers cannot afford to miss out on negotiated reimbursement. Most reimbursement reports can tell you how your price compares to a fee schedule, or per unit payment. However, because most providers charge for surgical services on time-based and/or acuity-based structures, it's difficult to see how the chargemaster price directly relates to the payment for a procedure. So, how do you know if you are actually missing out on surgical reimbursement?

Dynamic and Defensible

An encounter-level analysis of surgical cases is the best way to evaluate the effectiveness of your current surgical charge structure. Our Surgical Charge Analysis includes a systematic review of surgical encounters, which requires thorough payor contract analysis, reimbursement and surgical encounter modeling, as well as charge systems and process examination.

Through the clarity of these analytics, you can easily see what types of procedure charges fall short of reimbursement, in addition to how to adjust prices and structures to create a defensible surgical charge that generates full reimbursement on every case. Taking the time to guarantee alignment of surgical charges and reimbursement can keep your hospital in the black and help avoid pricing transparency pitfalls. The Surgical Charge Analysis includes the following critical elements:

  • Reviewing surgical charges and criteria against acuity and reimbursement metrics
  • Evaluating 835 payment data to validate payment accuracy with reimbursement contracted terms
  • Establishing a defensive acuity level definition and related time increments that accurately reflect actual case complexity and resource utilization
  • Establish a defensive pricing strategy based on current costs and acuity factors, while maintaining gross revenue neutrality or achieving facility-specific projected impacts

We’d love to hear from you

Schedule a call to learn how MedCom can help. 

Request a Demo

Recent Posts

Are Your Payers Covering the New Cost of Healthcare?

According to Becker's Healthcare, as of Quarter 3 of 2022, "economists have classified 2022 as the worst financial year for hospitals in decades," as the profit gap between payer and provider continues to widen. Figure 1.1 Note. ...

Read More

What is the Point of a Patient-Centric Revenue Cycle?

What it IS The patient-centric revenue cycle considers the patient's experience throughout the billing process. This includes an upfront understanding of the cost and transparent and timely communication regarding the balance due ...

Read More