Pricing

Hospital pricing methodologies that are transparent and defensible are crucial to patients, payers and the overall healthcare market in the current environment. All prices should be consistent, rational and easily explained to the public. In addition, prices should be designed to protect the hospital’s net revenue by not being below governmental fee schedule rates.

Benefits

Evaluation of current prices identifies discrepancies such as inconsistency in items with the same CPT code or more complex procedures priced lower than related simple procedures.


Comparison of current prices to the Medicare fee schedule provides baseline pricing.


Checking current prices of identified market competitors by service line and individual CPT code ensures a hospital is on par with peer hospitals.


A careful evaluation and timely review create a rational and defensible pricing strategy.

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Negotiating Health Plan Contracts: Best Practice Tips

For hospitals, “care” typically refers to providing patient care. Yet a hospital’s financial health requires care and attention, too.

A sound financial strategy supports the provision of patient care and services communities need, and a significant component of healthcare organizations’ revenue frequently comes from health plan contracts.

So what do your health plan contracts look like? Have you reviewed them recently? Are there opportunities to modify those arrangements to maximize your reimbursement?

Here are some best practice tips for health plan contracting.

Review your health plan contracts regularly –...


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