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Hello,

I am working with another member on a presentation.  I would appreciate any help on this subject.  if you are comfortable responding in this conversation or sending me a private response i would appreciate it very much.

1. if you could have one question about healthcare billing answered what would that be?
2. What is the type of service or product do you have the most difficulty with in presenting an appropriate price?
3. What software tool have you found effective and why?
4. What book reference have you found effective and why?
5. What is the hardest question you have to deal with in a deposition?
6. Any other issue concern or question?

i have been collecting questions from individuals who have reached out already.... and would appreciate under standing peoples pain points when it comes specifically to pricing out the services identified. 

First thank you so much for the questions i have received to date.  Those that have sent me info i have provided some preliminary direct reactions as a courtesy.  I have one theme that I feel the need to modify and respond generally to.  Mostly because I feel the need to provide alternatives to the subject.  The question in part involved transparency of data within the sources that aggregate charges (Fairhealth VA etc) .  I have two objectives in my response 1. the short answer is NO the data contained within the charge capture repositories ARE transparent - one just needs to understand the data and how it landed. 2. I am going to share one discussion I had with Fairhealth - I have at times used their information, abstracted it, then integrated it into my work product after i have analyzed my LCP as a whole.  During my conversations with Fair Health and the being a recipient of their explanation of their product - they have offered 'Hey you can direct anyone to explain our data' .....'you can defer any questions... we will make ourselves available' 

My second objective:  i would never make the following statement in a deposition "I defer the explanation of the data sources to the attorneys at Fairhealth"  What i would say is that Fairhealth in particular is very transparent with their data and information that in fact you can call them directly and ask any questions yourself."  Fair health is no different that any other data repository.  Regardless i am happy to explain on charge capture data repositories work......

Now onto objective #1 Transparency:  All charge capture data comes from claim forms. (I know months ago I provided specific details this is just a high level summary)

Facility

1. Hospitals have a charge data master (CDM) they have columns some of them a discretionary some of them are not.  For example, they will have a service description, a service number, an assigned revenue code (not discretionary), if applicable CPT/HCPC codes (not discretionary) unit price etc.
2. Charges are posted into a financial system as the patient receives services
3. when the patient is discharged a summary of itemized charges is processed
4. medical records inputs diagnosis codes, procedure codes and assigns a DRG group.
5. This information is populated into CMS 1450 form (the contents that feed this form ARE NOT DISCRETIONARY THEY ARE A MUST) The rules are embedded in HIPAA transaction codes in addition to a few other legislated rules. 
6. The claim form is what is abstracted by all of the data warehouses - because the definitions are uniformed, defined, and consistent, they become reliable.  
7. thus the statement regarding transparency is that these data bases are fed by cms 1450 forms (they represent provider charges) it does not matter who the payer is because the provider only has one CDM. Once a provider is captured within any data base you are indirectly getting their charge information.  The volume of claims in these data bases are huge (statically valid)
8. Finally for people who do bill review - if you have the itemized bill or the claim form - but especially the itemized bill you in essence have the relevant information from the providers CDM because that is where that data comes from.

This is the same concept for professional charges but they are sent along a CMS 1500 form.  Same concept.  The  reason why one should evaluate each individual condition before selecting a price for professional charges by percentile is because the charge capture data just provides the data, the LCP has to take into consideration the license type of the provider involved (MD,NP, PA etc) and the intensity of the healthcare condition being treated. 

So the data bases are transparent - they spell out what they have collected -   so if you hear a statement like well in my experience it looks like the providers charges on bill are always higher then what i see in the data base - well you can benchmark against the data point (which is without license type of diagnosis code) analyze your individual and draw a conclusion.  Remember even with the license type of MD a pediatric infections disease doctor earns about 230 k a neurosurgeon earns 900k.  The money from their income comes from CPT codes.  therefore, you always have to have context and condition. 

Thank you for your patience as I attempt to succinctly share experiences. Thank you for sending me your questions...

Hello,

I am working with another member on a presentation.  I would appreciate any help on this subject.  if you are comfortable responding in this conversation or sending me a private response i would appreciate it very much.

1. if you could have one question about healthcare billing answered what would that be?
2. What is the type of service or product do you have the most difficulty with in presenting an appropriate price?
3. What software tool have you found effective and why?
4. What book reference have you found effective and why?
5. What is the hardest question you have to deal with in a deposition?
6. Any other issue concern or question?

i have been collecting questions from individuals who have reached out already.... and would appreciate under standing peoples pain points when it comes specifically to pricing out the services identified.