Exception Analytics

Resource Utilization

Benchmark Pricing

How do your charges compare to local or regional competitors?

  • Enhance administrative strategic decisions with accurate market intelligence
  • Incorporate a market comparison component into your annual revenue modeling & charge master adjustments
  • Routinely monitor market trends

Are facilities of similar size and designation priced comparably?

  • Support in allocating and budgeting charge adjustments based on pricing capacity of similar type facilities
  • Transform raw data into "useful" information applicable to the appropriate setting
  • Strategically price new or expanded service lines

Are your retail charges defensible?

  • Proactively respond to local and national transparency initiatives
  • Balance public & governmental accountability with the organization's financial needs
  • Establish a baseline to improve your negotiating position with Payors and Networks. Commercial Payors have your competitor's data, do you?

Exception Analytics

Was your facility caught off guard by the release of CMS charge data?

  • Exception reports highlight service lines outside customizable tolerance levels
  • Understand how the public's perception of your pricing could differ from reality
  • Mitigate pricing disparities to minimize negative criticism

Are you losing business on "shoppable" procedures?

  • Easily identify common procedures where excessive charges could result in outmigration to other providers
  • Quickly access charge data for patient's price shopping for specific procedures
  • Proactively prepare charge structures for ongoing transparency initiatives

Where should you focus charge master adjustments?

  • Efficiently pinpoint service lines with significant pricing disparities to maximize aggregate charge master limiters
  • Improve impact through analytic evaluations of high volume service lines
  • Targeted revenue optimization based on competitive market pricing

Resource Utilization

Is your charge master working the way you intended when all charge items are taken into account for an entire procedure?

  • Validate resources utilized by procedure in comparison to defined peers
  • Identify codes & services missing from specific procedures
  • Pinpoint potential coding irregularities associated with reported "units"

Are you considering package or bundled pricing for specific procedures?

  • Validate current "Case" pricing for facility charges in relation to peer markets
  • Evaluate potential financial exposure and risk for selected episodes
  • Identify potential cost-saving opportunities for bundled payments

Do your clinical treatment patterns vary by Procedure?

  • Efficiently target variances in Procedure specific resources by Revenue Center, APC, & individual CPT-4
  • Minimize over-utilization to help control costs
  • Capture additional revenues where appropriate