Scientific charge master rate optimisation, knowing things that can go wrong and how to avoid them

Abstract

Optimisation of the charge master prices is an effective way to improve the net revenues of a hospital and is a fundamental part of strategic pricing. Today, scientific charge master optimisation (also known as a rate-opt) must be considered a mandatory activity, not only for maximising net revenues (typically at least 20 per cent greater than other techniques) but also to ensure government compliance, managed care contract compliance, and fair treatment of the uninsured, while providing transparency into the pricing process. Unfortunately, when improperly done, a rate-opt will not only fail to achieve the desired goals, but it will frustrate department directors and the finance group. This article discusses best practices for performing a successful science-based rate-opt, a highly leveraged tool in a hospital's financial inventory.