Healthcare provider prices are being scrutinized more than ever now with the Affordable Care Act in place. The demand for rational pricing is a major component to transparency, price competitiveness and earned reimbursement. It is imperative to ensure that your rates are justifiable.
The ParaRev Market Based Pricing (MBP) Program is designed to improve profitability by creating rational pricing methodologies that ensure transparency, price competitiveness, and earned reimbursement. ParaRev assists hospitals and providers in creating a rational pricing methodology and best practice for developing prices based on cost, reimbursement, and peer pricing data. This is done through identifying line items in the charge master which have negative patient satisfaction due to high prices, identify gross margin improvement opportunities due to low prices and help establish a rational pricing methodology by setting prices based on fee schedule, APC, cost, or competitive market pricing data.
ParaRev’s seven step process ensures that client data is loaded and accurately modeled, market position is assessed, project goals and areas of sensitivity are considered, gross and net revenue impact is determined (including stop loss, claim cap, and annual inflation cap adjustments), all prices are quality reviewed and smoothed, accurately implemented, and impacted quarterly.
The ParaRev Market Based Pricing (MBP) Program deliverables include review of existing prices, price transparency, market/cost based pricing, market analysis, contract modeling, a series of pricing iterations with recommended prices and quarterly post-implementation progress reports.
As each iteration is developed, a series of reports are generated to assist in the quality review of the iteration parameters.
Comprehensive pricing reports include:
- Grand Summary – Annualized summary of gross and net revenue impact including inflation cap, claim cap, and stop loss adjustments, and listing of iteration parameters
- Peer Pricing Hospital – List of peer hospitals used in the analysis
- Patient Type Summary – Unannualized summary of gross revenue difference by patient type
- Department Summary – Unannualized summary of gross revenue difference by department and patient type
- Payer Summary – Unannualized and annualized summary of gross and net revenue difference by payer including inflation cap, claim cap, and stop loss adjustments
- Payer Detail – Unannualized and annualized summary of gross and net revenue difference by payer and patient type including inflation cap, claim cap, and stop loss adjustments
- Contract Terms Summary – Listing of contract terms loaded into model by Contract and Patient Type including reimbursement methodology, values, inflation caps, claim caps, and stop loss thresholds
- Procedure Detail – Unannualized summary of gross revenue differences by CDM line item including reimbursement and peer pricing data
- Procedure Detail Less than Profee – Listing of CDM line items that have a current price less than the published Medicare professional fee schedule
- Procedure Detail Less than Hospital – Listing of CDM line items that have a current price less than the published Medicare CLAB, DME, or APC fee schedules
- Shoppable Services – Unannualized summary of gross revenue differences by CDM line for CMS Shoppable Services items including reimbursement and peer pricing data
- Cost Settlement – Unannualized impact of contracts with Cost Settlement Terms by department and payer
- Lessor Of – Summary of Lessor of Adjustments by Payor
- DRG Cases – Unannualized summary of gross revenue by DRG