HCPricing

09/12/2024

When we looked at payer reimbursement rates for six hospitals in Indianapolis, we found variations of 15% or more among reimbursement rates by payer and among compensation per location.

The takeaway: many hospitals may be undercompensated for services relative to their competitors.

Our latest blog outlines four data points hospitals can consider when looking at payer pricing data to fuel better pricing negotiations.

4 Data Points Hospitals Should Consider When Negotiating Pricing Contacts: Payer pricing data empowers hospitals to negotiate reimbursement rates. When looking at payer data, hospitals should consider these 4 data points. https://bit.ly/4dScPWS

Payer pricing data empowers hospitals to negotiate reimbursement rates. When looking at payer data, be sure to consider these 4 data points.

09/11/2024

How can payers make their pricing data even more accessible?

To make publicly available negotiated rates data more user-friendly, we suggest adopting the following practices to improve data quality and facilitate the extraction process.

1. Limit File Formats
2. Require a Table of Contents
3. Cap In-Network Files
4. Simplify Archives
5. Standardize Dates

These changes would reduce the barriers to gathering and processing pricing data,ultimately making pricing information easier for healthcare consumers to access and use.

Have questions about your price transparency files? Reach out to us to streamline your data process!

09/06/2024

How do payers reimburse hospitals for a patient office visit? The variation is striking.

- Lowest Average Statewide Compensation: $46.63 in Arkansas
- Highest Average Statewide Compensation: $132.43 in Alaska
- Highest Average Compensation Continental US: $107.70 in Colorado

Want to know how your state compares? Dive deeper into the data and get tailored insights on negotiated reimbursement trends. Contact us to learn more!

09/05/2024

Payers (whether health insurance companies or individuals) very rarely pay the gross price listed in a hospital’s chargemaster file for a service. But just how much do hospitals discount gross prices for patients who want to pay cash?

Across all services and hospitals, the average discount is 52%, or just over half.

Want to know how your local hospitals stack up? Unlock insights into pricing trends and healthcare transparency. Contact us today to learn more about how you can leverage this data for better healthcare decisions!

08/29/2024

When it comes to commercial payer rates for physical therapy, specifically therapeutic exercises, Prisma Health System exhibits a significantly wider range compared to Trinity Health System.

According to publicly available reimbursement data, Prisma Health negotiated reimbursement rates vary dramatically, ranging from $27 to $356—a $329 difference depending on the payer. Trinity Health negotiated reimbursement rates are more consistent, ranging from $16 to $251, with a $235 difference.

This stark contrast highlights the variability in payer rates and underscores the importance of understanding these differences for healthcare providers.

Are you aware of how your hospital’s negotiated reimbursement rates compare? Contact us for a tailored analysis and ensure your services align with market standards.

08/27/2024

Ever wondered how United Healthcare reimbursement rates vary across hospitals in Indiana?

We analyzed publicly available payer data to compare the minimum, median, maximum, and average reimbursement rates at Ascension St. Vincent, Elkhart General, IU Health Methodist, and Parkview Regional Medical Center for CPT 99386 - Preventative medicine evaluation and management service for a new patient aged 40 to 64 years.

Key Insight: Ascension St. Vincent has the highest maximum reimbursement rate at $308.93, which is ~$138.00 higher than Parkview Regional Medical Center's maximum rate of $171.04. This significant difference highlights the variability in maximum reimbursement rates across hospitals within the same state.

Are your facility’s payer reimbursement rates competitive? Contact us for a free analysis to ensure your reimbursement rates are at or above median market levels.

08/22/2024

When it comes to healthcare, understanding the difference in median insurance reimbursement rates across various payers is essential. Below is a snapshot of the median reimbursement rates for CPT 73721 (MRI of a hip, knee, or ankle) among four top payers.

What can Providers do with this data?

Leverage these insights to negotiate more favorable provider contracts at market average rates.

Not sure where to begin? Get in touch, we will provide you with a complimentary reimbursement rate analysis.

08/20/2024

Did you know? According to publicly available payer data, the lowest reimbursement rate a hospital receives for mammography is $81, recorded at Seattle Children’s Hospital. In comparison, the national average stands at $470.

Interestingly, the four hospitals with the next lowest reimbursement rates are in Indiana and Arkansas, highlighting significant variation in healthcare pricing.

Are you a provider looking to ensure that your reimbursement rates are at least at market median levels? Or do you want to know when your reimbursement rates are below market averages? Get in touch for a free analysis.

08/07/2024

If you’re located in Colorado, you’ll want to see these numbers. Median negotiated insurance reimbursement rates at Aspen Valley Hospital for a range of CT scans are…

- 66% – 81% lower than the median rates at Valley View Hospital.
- 8.4% lower than the median rates at St. Mary's Regional Hospital.
- 52 – 73% lower than the median rates at St. Vincent Health.

For example, for CPT code 72193 (CT scan, pelvis, with contrast), the rates are:

- Valley View Hospital: $593.40
- St Vincent Health: $420.10
- St. Mary’s Regional Hospital: $120.28
- Aspen Valley Hospital: $110.17

Understanding these numbers can help your hospital make more informed decisions and optimize your healthcare costs.

Get in touch for a detailed analysis of your local hospital rates!

08/06/2024

Trying to negotiate compensation for CT scans at a hospital in Sanford, SD?

Knowing how various payers compensate regional hospitals can make your job much easier. For example, according to publicly available payer data, UnitedHealthcare pays Sanford Canton-Inwood Medical Center just $934 to perform a CT scan, while it pays Sanford Clear Lake Clinic $1,850 and Sanford Chamberlain Medical Center $2,214.

Many factors can affect a service’s reimbursement rate, but a facility’s strategy going into negotiations can certainly impact that number.

Stay informed and strategize effectively! Reach out for your free sample of our detailed reimbursement rate analysis.

08/01/2024

We delve deep into hospital and payor pricing to bring you clear insights into the market. Our goal is to promote transparency and help our partners navigate the complexities of healthcare costs.

Below is a comparison of the average negotiated reimbursement rates for a colonoscopy among the four major health insurance payors.

- Cigna: $5,012
- Aetna: $4,916
- Anthem: $4,299
- United Healthcare: $3,399

This data highlights significant variations in pricing, which can impact decision-making for everyone in the healthcare life cycle.

Interested in deeper analysis?

Reach out and make sure you stay tuned as we continue to provide valuable insights into healthcare data and trends.

07/30/2024

Take a look at our recent analysis. A breakdown of charges for a CT scan at Central Montana Medical Center.

Curious about the rates at your hospital for a specific code?

Reach out to us, and we’ll put together a custom report for you.