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Transparent Pricing Methodology PowerPoint PPT Presentation


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Transparent Pricing Methodology. suite 200, 438 e wilson bridge road | worthington, oh 43085-2382 888-779-5663 | www.cleverleyassociates.com. Procedure Pricing Study. About the Procedure Pricing Study.

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Transparent Pricing Methodology

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Transparent Pricing Methodology

suite 200, 438 e wilson bridge road | worthington, oh 43085-2382888-779-5663 | www.cleverleyassociates.com


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Procedure Pricing Study

About the Procedure Pricing Study

The Procedure Pricing Study reviews a hospital’s prices at the procedure-code level and presents an analysis of suggested rate changes designed to enhance the defensibility and transparency of proposed pricing and to increase the amount of revenue collected per dollar of rate increase. This analysis is designed to allow management to impose a variety of restrictions on rate increases.

Additionally, Cleverley + Associates uses line-item detail from recent claims. This enables a more accurate review of projected recovery rates than simply using revenue-usage files.

Even if you have completed pricing analyses in the past, Cleverley + Associates can work with you to sharpen your adjustments. Changes in payer mix and/or contract terms can introduce new issues that Cleverley + Associates’ staff of analysts can help you resolve.


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Methodology Overview

Data

Client-submitted

Internal

CDM

Itemized Bill

Files

Payer

ReimbursementTerms

Supply &Pharmacy

CostDetail

Market-basedPricing

Modeling Assumptions

Contracts

Data

M o d e l i n g P h a s e

Deliverables


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Modeling

Model Assumptions

During the final stage in the Procedure Pricing Study, Dr. William O. Cleverley will assist you in creating a strategy for price adjustments, taking into consideration:

  • Pricing transparency

  • Cost-based pricing

  • Across-the-board price adjustments

  • Market-based pricing constraints

  • Self-pay recovery

  • Payer distribution

  • Other unique situations

Flexibility of Modeling

By working directly with Dr. Cleverley and our staff of consultants, you have the ability to fine-tune your constraints to meet your hospital’s unique needs. Even if you are looking to remain revenue-neutral or strategically lower prices to align with market needs, we can show you the most effective way to do so.


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Deliverables

The Deliverables

  • Price Defensibility Assessment

  • APC Charge Analysis

  • DRG Profile Report

  • Major Payer Contract Analysis

  • Exit conference call

  • CDM Review

  • Competitive Pricing Report

  • Mark-up Comparisons

  • Payer Impact

  • Percentage Change in Charges by DRG

  • Pricing Breakdown

  • Pricing Breakdown with Formulas

  • Procedure Pricing Recommendations

  • Recovery Breakdown

  • BETOS Groups

  • Optimum Chargemaster

  • Appendices A. B, C, and D–Charges by Payer, Charges and Profit by Revenue Code, Charges and Profit by Department, Potential CDM Issues


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Proven Results

Proven Results

Data on Cleverley + Associates’ prior pricing studies revealed:

  • Average profit from an across-the-board (ATB) rate increase was $10.8 million, or a recovery rate of 15.6%.

  • Average profit from modeling with price constraints to better align hospital prices was $13.5 million, or a recovery rate of 19.6%.

  • On average, each study generated $3.1 million of additional profit over and above an ATB increase while keeping prices better aligned with competitors and other market factors.

*Across-the-board


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Conclusion

One of the reasons Cleverley + Associates is a leader in the industry is our commitment to quality. We are with you every step of the way, helping youbuild financial strength.

Contact Information

Address

438 e wilson bridge road, suite 200

worthington, oh 43085

Phone

888.779.5663

Fax

614.413.3455

Email

[email protected]

Web

www.cleverleyassociates.com

www.transparentpricing.net

www.hospitaldx.com

END


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