Prolific Payoff

Ochsner incorporates technology from MedAssets to help it establish prices for hospital service by comparing current prices to market benchmarks, fee schedules, cost and relative value unit data, and Centers for Medicare & Medicaid Services' national, state, and hospital benchmarks. It also allows modeling of different pricing scenarios and forecasts the net and gross impact of pricing changes. Prices outside pre-established cost and benchmark thresholds are automatically identified to help providers adhere to established pricing policies.

Consumerism's impact
Teresa Loomis is three years into the revenue integrity initiative at Orlando Health, where she is the corporate director of revenue integrity for the six-hospital system, as well as South Lake Hospital in Clermont. She's responsible for making sure the chargemasters across the system are consistent. It's called "defensible pricing" in an era of calls for more pricing transparency in healthcare to accommodate greater consumer activism.

"No matter who the payer is, the goal is to be consistent with charging practices, according to Medicare guidelines so we can send out a compliant bill, prevent denials, and maximize reimbursement," says Loomis. Otherwise, "Medicare won't pay you for a particular DRG. They'll send it back for a redo, and if that's happening all the time, you can never get a handle on what's wrong with the process—you're just always trying to sort out individual problems and not fixing the process," she says.