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The CY20 OPPS Proposed Rule: A Response
The CY20 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. Read our summary here!
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Rate Advisor
We analyze hospital prices at the procedure code level and present an analysis of suggested rate changes designed to enhance the defensibility of proposed pricing with sensitivity to financial impact.
Contract Concierge
Coming soon! Contract benchmarking, modeling, and measurement through personal consulting with industry experts.
Strategic Advisor
We utilize extensive proprietary and public data sources to create fact-based, actionable plans to address specific client objectives.
HospitalDx®
Web-based software that creates custom analyses of financial/operating strengths, weaknesses, and opportunities. Utilizes client-submitted claims data as well as national public-use data.
Check Out The Latest Hospital Finance News!
Wednesday, March 11, 2020
Comprehensive APCs, aka C-APCs, are much like DRGs but on the Outpatient side. Comprehensive APCs expand CMS’s intentions of the Outpatient Prospective Payment System (OPPS) being a partially packaged system.
The official definition is:
“A classification for the provision of a primary service and all adjunctive services provided to support the delivery of the primary service.”
C-APCs are identified by HCPCS with assigned status indicator = J1 or J2. All c...
Wednesday, March 11, 2020
Laura Jacobson RHIA – Data Quality and Reimbursement Consultant
Laura is an expert on data quality and compliance issues, making sure our clients receive accurate and immediately useful results. She works with managed care contracts, modeling reimbursement terms for pricing and payment work. Her work allows our consultants to give accurate advice to help our clients be financially stable and successful.
Part of my job each day is to read through managed care contracts and decipher how ...
Wednesday, February 12, 2020
Two areas that affect the impact of contract changes include how payers define categories and services and hierarchies of payment.
A substantial provider-payer contract is nearing the renewal period. The payer initiates proposed changes to current payment terms, but the provider already has in mind specific outcomes desired for the upcoming contract year. The provider is faced with two choices; accept and move forward with the proposed changes or engage in the negotiation process. What sh...
Tuesday, February 11, 2020
Healthcare figures to be a primary issue in the 2020 elections, with much of the focus on costs — especially hospital costs. A common concern among users of hospital services is the apparent lack of correlation between hospital charges and payment. Although some hospital managed care executives have suggested replacing percent-of-charge (POC) contract provisions with fixed-fee payment as a solution, these proposals are based on three myths regarding the POC payment methodology relative to fi...