Our review is comprehensive and includes:
Items with CPT/HCPCS codes
Room and board charges
Items charged on the basis of time (e.g. OR, Recovery Room, etc.)
Items charged on the basis of levels
Cost-based items (e.g. pharmacy, pharmaceuticals, supplies, implants, etc.)
Clients select the actual hospitals to use as benchmarls for comparing prices.
The pricing model is custom built for each client using the CDM, actual contract terms, and revenue and usage data at the detail level.
Any pricing scenario that the hospital desires can be utilized to establish the new prices (e.g. strategically set prices based on charge codes’ net revenue sensitivities).
Comparisons of charges based on time can be conducted due to our proprietary methodology for deriving time charge benchmarks from claims data.
A multi-statistical approach to remove outliers from the benchmark pricing data is used.
Every price derived from the our model is reviewed to ensure prices are reasonable and are appropriately leveled (e.g. CT Abdomen With Contrast is priced higher than a CT Abdomen Without Contrast).
Prices with same CPT/HCPCS codes can be equalized across the hospital.
Ogoing monitoring of actual changes in gross and net revenues can be cnducted.
Prices can be established based on cost as a result of our proprietary methology of calculating the costs of procedures.
Impact of the price changes on outlier payments and cost-to-charge ratios can be determined.
