Listing of Services

Managed Care Strategy Audits

• Market intelligence on all major payors (self-funded employers, insurance companies, HMOs, PPOs, TPAs, etc.) currently in the market area, those likely to enter in the near future, and recommended specific contracting strategy to be followed by the organization for each.
• Summaries of market trends and market share information for payors and networks in your area.
• Summaries of contracted payors and networks at your hospital and hospitals in your area.
• Detailed research profile for each payor and each network in your area, summarizing general contracting strategy and typical contract terms.
• Summary of potential employer representation in your area.

• Optional Add-on: Medical Staff Managed Care Contracting Analysis: Evaluates existing Physician/MCO contract relationships.

• In-depth analysis of any ten ICD-9 procedure codes in your specifically defined "market", additional codes available.
• Your hospital and up to 5 competitor facilities identified by name, additional facilities available.
• Charge variability comparison using inter-quartile ranges, i.e. 25^th, 50^th, and 75^th percentiles.
• Investigation of Single vs. Multiple Procedure Impact upon coding and pricing.
• Resource Allocation Audit – by ICD-9, a comparison of charges and utilization by ancillary service area (Surgery, ER/E&M, Diagnostics/Therapeutic, Pathology/Lab, & Imaging/Radiology) for each facility. Assists in identifying where your facility may be over or under utilizing resources.
• Second level of analysis examining your facilities top 10 revenue intensive CPT-4 codes for each ICD-9 – comparing pricing and resource utilization.
• Customization available for additional facilities and additional codes.

• In-depth analysis of up to 50 CPT-4 codes in each of five ancillary service areas (Surgery, ER/E&M, Diagnostics/Therapeutic, Pathology/Lab, & Imaging/Radiology) in your defined "market", up to 250 total codes.
• Your hospital and up to 5 competitor facilities identified by name, additional facilities available.
• For managed care pricing purposes, Per-Visit pricing analysis, itemized by each facility, the entire market and statewide using 25^th, 50^th and 75^th percentiles.
• For charge master adjustment purposes, Charge Item Unit pricing analysis, for each facility.
• ICD-9 linkage analysis to the top 10 codes at your facility for each CPT-4 code.
• Exception reports and graphs provide easy identification of where your pricing falls significantly above/below the norm.
• Summary graphs of overall pricing levels by ancillary service area.
• Customization available for additional facilities and additional codes.

• Same as report above, for all CPT-4 codes reported within the database.
• Perform quick searches on an individual code or range of codes.
• Easy sorting and printing of report results. No additional software needed
• Define your own managed care categories and ancillary service groups by CPT-4.

• Identification of your hospital’s actual Medicare reimbursement for each outpatient.
• Determination of your hospital’s projected PPS Medicare reimbursement for each outpatient if the proposed APC system had been in place.
• Overall dollar and discount percentage results of the impact of the new APC system.
• Grouping of outpatients by clinical services, and sorting of data to identify those clinical services expected to be impacted the most by introduction of the new reimbursement system.
• Resource utilization analysis performed on the top 25 clinical service procedures most negatively impacted. These results are compared against both a statewide average for the procedure and a sub-set of up to five comparative hospitals.

• Side-by-Side pricing comparison of Medicare patients for up to 6 specific facilities.
• Identify where your pricing stands relative to the defined "market" and individual facilities.
• Both case mix and non-case mix adjusted statistics.
• Results are compared overall, by managed care categories, and by clinical service area.
• Analysis of both per diem and per case pricing to take into account length of stay differences.
• Comparison to statewide averages of per diem and per case charges.
• Custom options include: Corresponding comparison using Commercial patients (if data available), Detail down to DRG level, and Comparisons against more than one "market" (e.g., rural vs. urban markets).

• Identification of DRGs with the largest negative cost impact on the hospital’s Medicare reimbursement.
• For the top 25 DRGs, a resource utilization analysis will be performed based upon 25 revenue centers to determine the proportion of the cost derived from specific ancillary departments.
• These proportions will be compared to statewide averages and against a sub-set of up to five comparative hospitals.
• Determination of which ancillary departments and specific clinical service areas should be targeted for cost-cutting efforts to reduce utilization of resources.

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• Utilization per 1,000 for Medicare patients for every primary ICD-9 code in a 6 county region occurring at a statistically significant rate.
• Calculations based on patient county of residence.
• Identify outmigration issues by itemized utilization numbers at your facility versus other facilities visited by patients residing in your county.
• Comparisons against statewide utilization averages.
• Exception graphs visually display where your utilization falls above/below the norm.

• Utilization per 1,000 for Medicare patients for every individual CPT-4 code occurring at a significant rate in a 6 county region.
• Both per visit and per unit utilization calculated, based on patient county of residence.
• Identify outmigration issues by itemized utilization numbers at your facility versus other facilities visited by patients residing in your county.
• Comparisons against statewide utilization averages.
• Exception graphs visually display where your utilization falls above/below the norm.

• Simulates the impact of managed care contracts on your practice.
• Discounts are weighted based on your individual practices’ revenue mix.
• Easy to follow screens for data entry, data import and simulations.
• Summary reports provide individual discounts by CPT-4 plus overall weighted discounts.
• No special software needed. Runs on Windows 95 or 98.
• Current charges for the practice can be imported into the program or manually entered and modified when needed.
• Unlimited reimbursement schedules can be imported into the program, eliminating the need to enter reimbursement data (manual inputting of reimbursement schedules is still possible).
• Each CD is individually licensed to an individual physician.

• Individualized review of existing or proposed contract language.
• Custom response to payor(s) on existing or proposed contract language.
• Recommended negotiation strategy regarding the contract language.

• Detailed market intelligence about specific payors and their strategies.