(2) Healthcare Pricing Guide™ (HPG)
Backed by medical evidence, DDI has identified level of experience as the best predictor of quality medical care, and the best proxy to predict a good outcome; this is a measure that is available for every medical provider, both hospitals and physicians. Other attempts to measure quality have looked at adverse events such as mortality rates and hospital readmissions. These adverse outcomes should rarely occur, so they tell you nothing about most providers. Furthermore, when using adverse events to measure quality, it is important to adjust for patient risk, so providers do not avoid more risky patients, the ones most in need of care, but there is no universally accepted solution for risk adjustment.
Denniston Data Inc. adds hospital rankings to Provider Ranking System™ (PRS), integrated with its existing rankings of doctors.
According to The American Journal of Medicine:
High performing physicians result in better outcomes
Adding hospitals to PRS provides an essential tool for:
• Health Plans and Self-Insured Employers to use to select the best providers.
• Hospital Management targeting medical specialty areas in need of improvement.
• Physician Recruiters to ensure their hospitals have the best doctors.
Health plan prices negotiated with hospitals can vary from 120% of Medicare up to over 500% of Medicare
Ensure your hospital is paid fairly.
Healthcare Pricing Guide™ (HPG) is the first user friendly tool from just released Transparency in Coverage files as mandated by CMS, revealing negotiated prices from all healthcare payers for all services to all medical providers.
It includes the Qualifying Payment Amount (QPA), the new standard for price negotiation established by the No Surprises Act.
Compare your negotiated rates for each service to these standards, and use this evidence to maximize your fair reimbursements on those codes where your payments are lacking.
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