Revenue Optimization

HPA’s revenue cycle group has combined decades of experience in hospital reimbursement with deep knowledge of applied mathematics to build a unique, powerful analytics engine.

Charge Accuracy Analytics

CA runs over 100,000 tests on final billed claims to optimize the accuracy of hospital and physician charging practices. Using predictive analytics, we identify opportunities for improving documentation, coding, charging, and billing practices for both inpatients and outpatients. In addition to the analysis, we also track the status of past findings and accurately quantify the net revenue impact of implemented findings over time.

Many revenue cycle departments use a "claims editor" on the front end to catch errors resulting in denials. CA catches errors that make it through to the final bill, providing the insight necessary to identify and correct systemic errors resulting in lost revenue.

The service examines 100% of the claims for a given year using final billed (837) claims. This data is used for four separate analyses – Pairing, Ratio, Distribution, and Diagnostic Match. Within each major analysis, individual tests are used to identify specific opportunities for improved reimbursement. The CA analysis can run in almost any environment and is an ideal complement to claims editors and other tools, finding data relationships not found by other solutions. Claims editors can be used as a means of implementing many of the CA findings efficiently. 

Pricing Analytics

With increasing focus on pricing transparency, having a reliable method for managing the complexities of a large chargemaster is more important than ever. PA fully automates the process, providing a rational, competitively appropriate and compliant charge for every item, while optimizing net revenue based on your strategy and business rules.

The PA model creates a highly customized, fully automated net revenue calculator for each client we work with, leveraging today's enormous computing power to mathematically optimize price-sensitive net revenue. 

With a patent-pending rules engine and a database of more than 9500 proprietary “Set ID’s”, we uniquely optimize and manage the relationships between related codes. The client’s payer contracts are modeled with greater granularity and business rules are implemented more precisely.  

The key results are incremental net revenue and documentation of the basis for every gross charge. In addition we provide secure web access and the ability to do "what-if" modeling to support contract negotiation, accurately estimating the net revenue impact of competing alternatives.

  

Our Experience

Our team has extensive experience working with a range of hospital clients in 24 states, including:

  • Large teaching hospitals

  • Community acute care hospitals

  • Critical Access hospitals

  • Integrated delivery networks

  • Outpatient clinics

  • Ambulatory surgery and Imaging Centers

  • Inner city and rural facilities

In addition, we offer other revenue cycle services, including…

  • Disproportionate Share Recovery

  • Transfer DRG Recovery

 

Surgical First Assistant In-Sourcing

For many hospitals and surgery centers, providing competent surgical first assistants is of strategic importance in maintaining surgeon satisfaction and peri operative efficiency. 

Our Surgical First Assistant in-sourcing program is a flexible staffing solution that provides trained professional surgical first assistants (SFA's) to hospitals and surgery centers wishing to reduce staffing and training expense, increase throughput, and provide the best possible support for surgeons and their patients. The program is implemented with no financial investment and no disruption to the surgical team.

 

Pricing Analytics is the most effective solution for implementing rational, optimized strategic pricing. 


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