The objective of the Strategic Pricing Analysis is to develop defensible prices that improve the bottom line and are an alternative to an across-the-board price increase.
The scope of the Strategic Pricing Analysis includes all active items that are contained within the Chargemaster. All departments, service lines and disciplines will be included in the analysis. In addition, PPS provides a review which includes all managed care payors and every type of managed care contract term (e.g. percent of charges up to a cap).
- Services with CPT/HCPCS codes
- Room and Board Rates
- Operating room and recovery room time charges
- Outliers are modeled for compliance
- Specialty time charges (e.g. pain services, ENT, endoscopy, etc.)
- Items charged on the basis of levels
- Cost-based items (e.g. pharmacy, pharmaceuticals, supplies, implants, etc.)
- “Lesser of” contract provisions
- Commercial outlier and stop loss contract provisions
- Caps on charge increases for items paid at a discount off charges
- Revenue and usage data
- Claims data
- Managed care contract terms
- Comparable facilities’ prices
- Medicare and commercial payment rates
- Desired pricing scenario
PPS can also conduct ongoing monitoring and provide comparisons of the actual results to the projections.