Provider services and solutions

Financial performance: Charge capture and pricing

The challenge

Improved charge capture. Better compliance with payer guidelines and government regulations. Fewer denied claims. More timely reimbursement. Better staff appreciation for cost reporting. All benefits of maintaining a detailed and up-to-date charge description master (CDM). A CDM lists thousands of items your hospital could bill to a patient, payer, or other provider. Although a CDM can help justify charges, providers rarely recover actual costs. Despite this limitation, an accurate CDM can help you through the complicated process of setting prices for your services.

Most providers struggle to set prices that make services at least marginally profitable yet don’t exceed what insurers, individuals, and the government will pay. You must consider many factors. Publicly available charge data. Your hospital’s own cost information. Competitor pricing. Public and private payer fee schedules. Consumers, who pay a larger share of their healthcare expenses, need detailed price information to help them make treatment decisions and choose among competing providers. This public demand for transparency means that you must carefully--and continually--calculate, monitor, and adjust your prices.

How we can help you

• To set realistic prices and ensure fair payment for your services, your CDM must be accurate and complete.
• We can analyze your CDM for accuracy, completeness, and compliance with regulatory requirements.
• Accurate and thorough charge capture can bring in more revenue.
• We can improve your charge capture processes by finding and remedying shortcomings in coding, IT, and management reporting. We can design a charge capture infrastructure. We can evaluate your current charge structure to identify charges that fall below the Medicare Fee Schedule.
• You need to evaluate your charge capture process and pricing methods. Charges should be accurate and compliant with payer guidelines and reimbursement regulations. Pricing should be transparent and competitive.
• We can incorporate market-driven and cost-based pricing into your pricing calculations. We can help establish a central pricing office to provide patients with timely quotes. We can review bundling and unbundling protocols.

Common services include

• Analyzing your CDM and charge capture process for accuracy, thoroughness and compliance with payer guidelines and reimbursement regulations
• Formulating rates for uninsured patients
• Recommending methods to realign and adjust service categories with appropriate additions, deactivations and variances to the CDM