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Old 06-01-2018, 11:54 AM
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Edward Edward is offline
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Default Pricing facility services to Medicare

Does anyone reprice hospital claims (inpatient and/or outpatient) to Medicare to index the hospital's contracted rates as a % of Medicare? If so, what do you use?

I'm hoping there's a solution where you just feed it the necessary data (DRG, dates of service, rev codes, etc) and the program would output the Medicare rate. A google search turned this up as an option (http://www.microdynmed.com/Products/...y/priceractive) but wanted to get feedback here first.

I know how to price professional claims, but facility/outpatient claims are trickier. Thanks!
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Old 06-01-2018, 01:58 PM
Actuarialsuck Actuarialsuck is offline
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Originally Posted by Edward View Post
Does anyone reprice hospital claims (inpatient and/or outpatient) to Medicare to index the hospital's contracted rates as a % of Medicare? If so, what do you use?

I'm hoping there's a solution where you just feed it the necessary data (DRG, dates of service, rev codes, etc) and the program would output the Medicare rate. A google search turned this up as an option (http://www.microdynmed.com/Products/...y/priceractive) but wanted to get feedback here first.

I know how to price professional claims, but facility/outpatient claims are trickier. Thanks!
Yeah you want to get a pricer. Even on the Inpatient side where it's DRG based it can get tricky given short length stays, outlier stays, etc.

Outpatient is even worse because of the mess that's APC methodology.
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Old 06-07-2018, 05:00 PM
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Jemaine Clement Jemaine Clement is offline
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Edward, I just left you a private message.
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