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Obtain Third Party Contracts and Fee Schedules
Conduct Strategic & Defensible Pricing Analysis
Compare Prices to Competitive Market Pricing Data
Obtain Charge Description Master and Claims Data
Determine Pricing Strategy
Compare Prices to Cost of Service
Compare Prices to Medicare APC and Other Fee Schedule Rates
We assist our client’s to review and update their hospital and physician prices and to assess the financial impact of strategic and defensible pricing. We have performed strategic and defensible pricing reviews for our clients for over 30 years. A pricing analysis is not only a price analysis, but also a detailed reimbursement analysis. We utilize our many years of pricing analysis experience and our many years performing numerous reimbursement studies of all kinds for our clients. You need to understand the full ramifications of your pricing decisions in order to appropriately and responsibly perform this service.
Our approach is very straightforward and promotes a team approach with our clients. Our approach is summarized in the following major work steps:
In conducting the pricing analysis, we determine the financial impact of all pricing decisions, utilizing our proprietary simulation software model. We compute the financial impact on each line item of the Charge Description Master, utilizing the claims data and payer contracts and methodologies.
Once we have conducted and reviewed the initial results, we meet with our client's to review these results, make preliminary decisions, and make necessary revisions. This data should then be reviewed with specific departments to garner their input of sensitive market and/or pricing issues. Once we have received all feedback, we make the necessary revisions from the initial analysis and refine the prices to arrive at an updated pricing structure.
Our deliverables include summary reports, payer methodology reports, payer summary reports, pricing by department reports, and pricing by department by procedure reports, all showing the financial impact before and after price changes. We would also provide an updated Charge Description Master. Implementation is straightforward and allows our client’s to make changes to the individual procedure rates on the Charge Description Master. Throughout our analysis, we discuss with our client’s any issues that come to our attention such as obsolete or new CPT/ HCPCS codes, Charge Description Master codes with little or no activity, and other important issues.