Health PlanWe analyzed millions of Medicare Advantage claims to help one health plan manage the performance of their provider contracts. We found they were paying about 50% more than Medicare for most hospital outpatient services. This led to a detailed review and assessment of hospital outpatient provider contracts. We subsequently provided education and assistance on the implementation of an APC-based approach to reimbursement. |
ProviderTo ensure that a commercial payer was paying a network contract in compliance with terms derived from Medicare rates and policies , we analyzed a year’s worth of claims data. We discovered incorrect Medicare reimbursement rates and significant underpayments in certain areas. The results provided the hospital with the information needed to renegotiate the contract. |
Medical Technology CompanyThe maker of an implantable cardiac device needed hospital-specific procedural data in order to better plan its clinical trial, and understand the market for its device in preparation for future product launch. We were able to quickly and efficiently provide a detailed report of all hospitals in the US that provide selected cardiac procedures to Medicare patients, ranked by volume and mean length of stay, charge, and payment. |
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