Maximizing Charges

The Challenge:  
Most managed care contracts have "lower of" provisions that allow the insurer to pay the lesser of the provider's listed charge or the allowed amount in the payor's fee schedule.  Very often, this results in a significant amount of lost revenue opportunity unless a consultant is brought in to perform a charge master review.  Due to the voluminous size of most charge masters, those reviews take lots of time, are subject to human oversight and cost a good deal of money.  Many times, the consultant locates charge items that are old and no longer instituted anyway.

In addition, many payors now pay a flat rate or group rate payment for outpatient surgical procedures, built upon this same "lower of" principle.  If your package of charges falls below their established rate for the service rendered to the patient, you only get paid your charges rather than the higher flat rate or ASC group payment.

If you don't charge enough, you won't get paid enough.  It's that simple.

The Solution:   
Let Harvest's Charge Maximization tools monitor all your claims to see if you have charges set below allowed fee schedule rates.  Not only is this an automated process, it is very exact.  Plus, Harvest will not only let you know if your charge was below a particular payor's fee schedule, it will determine the highest allowed amount among all your payors for that particular service.  Now you can set your rates high enough so all your contracted payors will use their fee schedule to reimburse you the maximum allowed amount.  Harvest performs this same exercise on a package of charges in the same way.  In both cases, these tools provide you with a significant revenue opportunity almost from the day you install the system.  And over time, not only will your payor's fee schedules change but also your charges, making an automated tool like this a valuable on-going asset.
Increase your bottom line...

• Locate charges set below published fee schedule rates.
• Determine service charges set below a package flat rate or ASC group rate.