Strategic Pricing and Reimbursement Reviews/Modeling
Health care providers are facing increasing pressure from insurers and patients to provide transparency and comparability in service pricing. The growth in retail medicine and the out-of-pocket costs paid by patients are forcing health care organizations to develop defensible market-based pricing for services. Wipfli has the tools and processes to help organizations prepare for this new reality.
Areas of Expertise
- Professional (CMS 1500) and technical (UB-04) claims and related data
- Hospital revenue codes, CPT, and HCPCS coding
- Ambulatory payment system reimbursement (APCs)
- DRG-based reimbursement models
- RBRVS, provider-based, and other reimbursement models for physician services
- Bundled/unbundled services
- Access to state-specific and federal claims data for price comparability at the CPT level
Types of Services
- Strategic pricing model for hospital services using competitive data:
- Modeling changes in gross revenue and reimbursement by type of service based on competitor analysis
- Developing tools and templates to support pricing of new services
- Modeling pricing based on Medicare reimbursement levels
- Ensuring that pricing for same/similar services is aligned within multi-hospital systems
- Strategic pricing model for physician services using RBRVS, reimbursement, and competitive data:
- Understanding sensitivity to existing fees, market pressures, and patient perception
- Focusing on code categories and their specific issues (E/M, surgery, medicine, radiology)
- Modeling changes in net revenue by code, by clinic, or by department
- Developing pricing template to support pricing of new services
Contact: Jane Jerzak or Vicki Mueller