| Title:
Negotiate Favorable Payer Rates with Transparency Data
Presenter: Govind Goyal, MS, CRCR President, Financial and Revenue Integrity Services with Panacea Healthcare Solutions and Natalee Hall, Senior Financial Analyst, Financial Services with Panacea Healthcare Solutions
Length: 57.57 Minutes
Description:
Learn how to use data files to help negotiate payer rates.
Objectives:
- Industry Updates and CMS Actions
- Hospital vs Payer Machine-Readable Files
- Improving the Integrity of Negotiated rate Data for Comparable Use
- Demonstrated Use in Strategic Pricing and Contract Negotiations
Key Topics:
- CMS Price Transparency
- Increased Enforcement
- Industry Statistics
- Key Dates
- Transparency in Coverage vs CMS Price Transparency
- Attribute Comparison of Machine-Readable Files
- TiC-Negotiated Arrangement and Negotiated Type
- Size Matters
- Payer MRF – Sample Anatomy
- Comparison Examples
- Case Study
- Challenges with Payer Machine-Readable Files
- Transformation Process
- Building Your Peer Group
- Classification of Disparate Payer / Plans to a Standard Payer and Plan
- Meaningless Variation in Negotiated rates between Product Types
- Hospital Analysis – Meaningful Variation in Negotiated Rates with Same PPO Product Type
- Rate Methodology not required in Hospital MRF
- What happens if you don't control for Rate Methodology?
- Incorporating the Rate Methodology
- Disparity by Rate Methodology for Same Service
- Confidence Level by Frequency of Rate Methodology
- Importance of Removing Outlier rates – CBC Lab test
- Service Line Analysis: Raise Prices or Negotiate Better Rates?
- Payer Analysis
- Selecting Your Reports
- Example Comparison Report – Radiology Services
Govind Goyal, MS, CRCR, President, Financial and Revenue Integrity Services
Panacea Healthcare Solutions
email: ggoyal@panaceainc.com
Natalee Hall, Senior Financial Analyst, Financial Services
Panacea Healthcare Solutions
email: nhall@panaceainc.com
https://www.panaceainc.com/
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