Using advanced mathematical models to provide defensible, reproducible and pricing structure to Charge Description Masters.

Healthcare Pricing Experts

Actively manage your Charge Description Master pricing

Hospitals deploy Charge Description Master(CDM) teams to review the charges and determine the new CDM that will then drive payer managed-care contract negotiations downstream. But CDMs have many line items and hospital resources can have limited time for review. This is a perfect storm for missed opportunity that will impact revenues and profits.

Charge Description Master Optimization

Our Charge Description Master (CDM) Optimization services provide a science based approach to determine the best charges and rates given the geographic market you serve.

The next step beyond manual manipulation of the top charge codes is optimization whereby all charge codes are priced. Our optimization model has been vetted many times over in single hospital setting or hospital networks.

By considering C-level strategic directives, competitor information, population demographic changes, and economic indicators, CDM prices for all charge codes will be derived to optimize revenue, service-line, and product-line objectives. In addition, since we combine data from different sources and connect visits and encounters to your managed-care contracts, we provide Business Reporting dashboards to allow deeper analyses of the encounter data and pricing results.

Managed-Care Contract Optimization

We provide the necessary data/pricing analyses and reports on contract performance to help hospitals negotiate with their payers.

Our process involves modeling each contract (fixed fee schedule, POC, T&Cs, lesser-of clauses) and processing all claims and billing against the contract, thereby creating real realized reimbursement rates and revenue vs contracted rates.

Our optimization solution can provide per diems, POC /DOC, DRG case rates, capitation payments, patient profiles and reimbursement rates at reduced risk exposure.

Our transaction analysis engine analyzes all patient billing with respect to contracts. That is, starting with a CDM charge code, we calculate the path to final billing. This is unique among consulting providers, and provides insight into complexities that arise due to competing contract stipulations.

Codarex Service Offerings

Contact us to discuss how our services can augment your Charge Description Master review team and Managed-Care Contract review team.

We can provide the data handling skills, complex pricing modeling and reports to deliver the necessary information to drive best possible pricing decisions. Furthermore, multi-year contracts have a considerable discount, since, from our prospective, the heavy lifting is done in the first year, and the process repeated every year thereafter with minor adjustments.

Be proactive with your pricing needs and establish protocols based on best practices in pricing.

About Us

Codarex pricing experts have backgrounds in mathematics, statistics, engineering and other computational fields.

We apply the Agile Delivery Framework to ensure we are on target, on time, on budget and reduce engagement risk. We iterate and review results often to converge to the target.

We leverage our experience within the healthcare, as well as our experience in other verticals to bring the best pricing practices to solve pricing problems.

With our consulting partners or independently, we have been engaging hospitals and healthcare companies since 2001. One of our healthcare solutions was a finalist in Franz Edelman Award for Achievement in Operations Research and the Management Sciences.

You can trust in our experience and expertise.

Codarex Services

Over the years we have refined out service offerings. We offer Charge Description Master Optimization as a consulting engagement and a subscription model. A single consulting engagement could be for a single hospital or a hospital network and it would follow our standardized process.

In our subscription model, we trade incredible savings for a longer term commitment. As described above, our methodology is standardized. Hence we can leverage all the upfront effort by both our customer and Codarex for data connections, contract modeling, CMS data requirements, etc. to perform it once and we perform necessary updates as required for future CDMO.

For first time clients, we suggest the consulting engagement, so that the client can vet our process, outputs and our talent. Then when our client feels secure, we convert the single consulting engagement into a subscription model.

Typically our clients ask for a single CDMO for the annual process, however, with our process we can perform any desired frequency of charge description master updates. We could perform bi-annual and quarterly updates is so desired. One of the main reasons this would be of interest is that hospital managed-care contracts are not all reviewed at the same time nor within the same quarter.

Currently, we perform Managed-Care Contract Optimization on a per contract review basis. Although a hospital or hospital network can have hundreds of contracts, the 80/20 rule reduces the total to a small set which account for 80% of billing. We offer a subscription model for the primary 10 contracts if so desired.

Feel free to contact us to learn more about how Codarex leverages advanced mathematical approaches to standardize the Charge Description Master pricing review and setting process, and how we can augment the analytical capabilities of your managed-care contract negotiations.

Contact Us

Contact Antonio Ruggiero at aruggiero@codarex.com to discuss how our services empower your CDM team with advanced analytics to drive decisions.

Charge Description Master Engagement

Our process for Charge Description Master Optimization (CDMO) incorporates Agile Delivery Methodologies. We define an initial state for optimization and iterate often to obtain the final solution. Our projects are standardized and include

Requesting data
- Patient billing information, top 6-10 contract conditions, room resource usage (if availability)
- Initial report for data agreement
- Data loaded into our Business Intelligence and Reporting system
Consultation meeting to obtain corporate primary goals and secondary constraints, Agile Delivery
Add CMS data for geography and other attributes
Iterate
- Produce optimization output for CDM and share for review
- Accepts portions of output and adjust optimization constraints to iterate on remaining charge items
Final outputs
- CDM for ingestion into HIS
- OIG report
- Standard reports and dashboard documentation

A standardized process translates into defensible pricing and no surprises.

Managed-Care Contract Engagement

Our process for Managed-Care Contract Optimization (MCCO) incorporates Agile Delivery Methodologies. We are embedded in contract negotiations to support our client's needs. We provide optimized outputs and analyses to support our position. Interaction complexity is high, and trying understand how a contract change will impact total contract performance is difficult. A fundamental input for MCCO is a solid chargemaster. This will be the bases from which contract reimbursement rates will be determined. Our process involves

- Modeling each contract and processing all claims and billing information against the contract terms and conditions, thereby creating a top-down view of a contract's historical performance
- Adding competitor hospital charges, market information, and other data, to perform bottom-up pricing to reconstruct a payer’s contract
- Determine per diems, POC/DOC, DRG case rates, capitation payments, patient demand profiles, and reimbursement rates at reduced risk exposure

These results are used to drive a hospital's negotiation with payers.

Be prepared and on the same footing as your payers. Use the same analyses that drives their decisions and make your case based on analytics instead of gut feel for the future.

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