HealthCare Consulting Solutions

Revenue Cycle Solution Services

Charge Capture Assessment

Review, assess and target critical departments to identify process improvement, charge identification and charge capture opportunities to ensure appropriate reimbursement by enhancing net revenue, reducing denials while enhancing data integrity and overall billing compliance. Education of staff, redesigning process, and establishing and tracking goals are critical to implementation success.

Complementary solutions include comprehensive chargemaster assessment, strategic pricing analysis and coding/documentation improvement audits enhance the charge capture assessment.

Hospital Dashboard Report

The Hospital Dashboard Report is the most comprehensive financial evaluative tool available for hospital boards, hospital management, and hospital creditors that is provided by an independent agency. The scoring systems used are proprietary and are based upon 30 years of extensive hospital financial analysis and research by the firm and its principals. They have been empirically validated and found to be both excellent predictors of future financial conditions and effective diagnostic tools that can be utilized for self improvement.

The Hospital Dashboard Report compares the primary facility to a peer and a peer average across a number of critical financial performance drivers. This gives executives an excellent tool for benchmarking hospital performance and identifying potential issues before they become real problems.

The Hospital Dashboard Report combines financial performance measures with market factors, and pricing and cost figures in an action-oriented, board-level report.

APC Financial Review

The APC Financial Review examines the profitability of departments/service lines under the APC system. Clinical areas with the greatest potential for improvement are targeted allowing facilities to direct resources efficiently and experience reimbursement recovery where possible.

The APC Financial Review provides:

  • Profitability (APC payment less cost) by product line and APC
  • Outlier payments by APC to identify possible future losses
  • Percentage of charges bundled into the APC fee compared to that of other hospitals
  • Average CPT/HCPCS procedures billed or performed per claim compared to those of other hospitals shown by product line and APC

Competitive Pricing Report

The Competitive Pricing Report compares a hospital's prices at the CPT/HCPCS level with those of local competitors. It summarizes those areas in which a hospital's present prices are high or low relative to those of competitors. Specific procedures in which rate increases make the most sense are clearly defined. This report also identifies procedures in which rate increases may hurt either the hospital's competitive position or its public image. The Competitive Pricing Report is exceptionally useful in managed care negotiations.

  • Comparison to competitors
  • Detailed competitor prices at the CPT/HCPCS level provide useful tools for justifying prices to managed care firms.
  • Identification of areas of possible rate increases

Strategic Pricing Assessment

The Strategic Pricing Assessment illustrates the potential profit impact of suggested pricing changes and profit-sensitivity analysis based on defined constraints. Cost relationships are incorporated into pricing algorithms, where desired by the hospital, and the effect of pricing changes upon hospital profit is determined. We integrate competitive data where possible to help identify areas in which potential rate increases will have minimal effect upon market share. Separate schedules also identify the impact by payer to isolate which payers will be most affected by pricing changes.

The assessment incorporates specific constraints provided by management, which include price/cost relationships and competitive pricing restrictions. Our work is unique in the accuracy and detail of our analyses and conclusions. We define a unique recovery rate for each procedure code in the CDM that measures the incremental effect on net patient revenue resulting from a pricing change. The recovery rates are determined through our detailed modeling of all hospital contracts, incorporating specific contract provisions such as carve-outs and outlier provisions. Contract payment provisions are then related to specific line item-level claims data taken from a three- to six-month review of actual claims.

The assessment provides the Hospital's Executive Team with the most comprehensive review of prices, for the various methodologies, so the Executive Team can properly balance the two major conflicting goals, as we've seen nationally over the past 18 month: a) First, the hospital's need to generate a reasonable return on its investment to remain financially viable. b) Second, hospital executives concern with public reaction to prices that might be viewed as too high or unreasonable.

For more information email
or contact us.