It is essential to prepare for upcoming changes to outpatient prospective payment systems and classification to the Inpatient-Only listing of services by assessing the procedures performed in your operating room along with its cost and current vs. proposed reimbursement. With the upcoming changes to the Inpatient-Only listing, likely, reimbursement for these services will also change. Commercial payors use the “lesser of” provision in contracts, indicating the assignment of remittance at the “lesser of” either billed charges or negotiated payment. That means providers must adjust prices for services that will move to the inpatient-only list to obtain accurate reimbursement consistently.
How to Start
An encounter-level analysis of a year’s worth of surgical cases is the best way to measure the potential impact of the services that will be moving back to the inpatient-only listing. Evaluating these encounters against the expected government and commercial payment methods clarifies where opportunities exist to change price and structure to achieve greater defensibility and eliminate potential missed reimbursement.
When surgical charges are not stratified based on a reliable and defensible method, it is challenging to assign prices that accurately reflect service acuity and earn proper reimbursement.
Contact us today to learn more about establishing a nimble charge structure and defensible pricing strategy for surgical encounters and preparing for upcoming payment changes in 2022.
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Our Chargemaster, Pricing, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.
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