Charge Capture
Credit Balance Management
Strategic Pricing
Underpayment Recovery

ISSUE:
Three independent hospitals merged together to create a billion-dollar health system. Though all three facilities were served by a common HIS, each one continued to operate using three separate database platforms. Concerted efforts were made to keep these distinct platforms uniform per the health system's mission to create a standardized, seamless billing processes, but over time the rigors of such distinct and separate maintenance resulted in – among other issues – an incoherent CDM. Prices, descriptors, modifiers, revenue codes, and CPT/HCPCS codes all varied significantly across facilities even for the same exact charge. Having to manage three separate CDMs with static and disjointed price structures prevented the health system from articulating a clear pricing strategy and caused significant revenue leakage.

SOLUTION:
After discovering that a traditional CDM maintenance tool was unable to address the complex data analysis required to align multiple CDM databases, the health system turned to MethodCare to leverage more precise and timely methods of analysis to drive strategic pricing and CDM standardization.

Using MethodCare's CDM Strategic Pricing Solution, the facility identified in an automated fashion and within less than 90 days all chargeable line items, which were likely intended to be identical but deviated in some critical aspect (the price, assigned code, hard-coded modifier) – an undertaking the facility had previously believed would require a team of chargemaster consultants and six months to one year's time. Additionally, the solution targeted strategic pricing misalignments by simultaneously analyzing prices in the context of similar charges in the health system, national charge percentiles, local market data price levels, facility-defined RVUs and detailed contract logic in place enterprise-wide. Using MethodCare's customized algorithms the CDM director could for the first time analyze numerous data points at the chargeable line item level and implement the required standardization changes in a similarly automated fashion. The technology innovation drastically reduced the time and resources the health system believed was required to address such an overarching issue

RESULTS:
$4.5 million increase in net revenue
Charges are uniform, transparent and defensible enterprise-wide
Results delivered 50% quicker than any competitive solution