Children’s Hospital Models True Financial Impact of Chargemaster Pricing
April 21, 2021
This organization drove results and impact
Modeled reimbursement impact to drive down denials
Saved weeks of manual, tedious effort by transitioning to automated modeling
Armed leaders with information on impact of their decisions to reimbursement
Inability to Analyze Impact of Pricing Within Current or Future Contracts
Because contract data and chargemaster data reside in separate systems, healthcare organizations often struggle with understanding the financial impact of their pricing. Unable to analyze changes in pricing within current or future contracts, providers miss significant revenue opportunities that contribute to improved margin.
One of the nation’s top children’s hospitals needed to better understand the impact of pricing on reimbursement, revenue, and margin. In the past, analysts would have spent weeks pulling data from thousands of accounts to make an estimate in one area. In one example, this hospital received denials for separate neuro-monitoring charges and wanted to begin bundling these charges at the OR level to avoid future denials. First, they needed to understand the impact of that decision.
Model Impact of Chargemaster Pricing
This children’s hospital leveraged StrataJazz® Strategic Pricing to better understand how pricing changes would impact reimbursement and revenue. The organization used the tool to integrate cost, chargemaster and revenue data from disparate systems for a true understanding of margin impact. They leveraged automation to model the impact of changes to neuromonitoring prices that would help them compete in the market and build trust with their patients.
Within less than a year, this organization has used the tool to model the impact of removing or altering charges from several departments, including genomics, nutrition services and implants. The team is now using Strategic Pricing to determine the impact that changing supplies would have on reimbursement. They have begun assessing over 9,000 charges to understand the impact of moving or combining charges within their room & board line item.
Understand the True Impact of Chargemaster Changes on Net Revenue
Using StrataJazz Strategic Pricing, this children’s hospital has increased revenue and driven down denials by making strategic, defensible pricing decisions. Bundling their neuro-monitoring charges allowed them to reduce related denials and gain revenue. Leaders now make informed decisions based on seeing the real impact that their pricing changes would have.
The hospital has eliminated weeks of tedious, time consuming work. The resulting process now takes a maximum of two hours. Their revenue integrity team now uses the model to identify ways to boost price transparency and anticipate the impact of changes before they make them. Strategic Pricing is also helping them adopt pricing transparency by making their chargemaster more legible for patients. As a result, this children’s hospital has transformed a highly manual, time-consuming pricing analysis into a significantly more efficient, accurate and insightful process with a more defensible pricing strategy.