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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

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