Restructuring of the hospital’s chargemaster in this era of transparent pricing often results in material increases and decreases in line item charges to align with market norms, unit costs, or a hybrid thereof. Learn how your organization can enhance its financial performance in this environment in our whitepaper.
Historically healthcare organizations establish chargemaster prices for new services at some multiple of the Medicare fee schedule or ambulatory payment classification (APC) amount. This practice, combined with the realignment of charges to become more rational, has caused hospitals to lose hundreds of thousands of dollars in payments—often unknowingly. Thus it is important to identify or estimate the financial opportunity or risk that the current and new chargemaster prices trigger under lesser-of-charge (or fixed-fee) and stop-loss clauses in payer contracts.