Charge Integrity Solutions

Comprehensive revenue capture, cost recovery and defensible pricing are all essential for today’s health care organization to thrive. Turn to nThrive’s full suite of solutions to ensure compliance and optimal revenue performance.

Chargemaster

Health systems are challenged to maintain an accurate and compliant chargemaster, given limited staff and resources to manage thousands of continually changing charge items and regulations that adversely impact pricing, revenue, costs and credibility.

To overcome the challenges of cost recovery, accurate charging and compliant pricing, nThrive delivers a complete, web-based chargemaster that covers inpatient and outpatient charge items for the entire CDM. Use nThrive’s optimized CDM technology and services to:

  • Achieve comprehensive revenue and cost capture for the entire CDM, not just coded line items
  • Prevent revenue loss with nThrive technology that identifies invalid charge codes 
  • Benchmark pricing for more than 390,000 charge line items with nThrive’s Preferred Practice Model, including proprietary line items for surgery, pharmacy, supplies, procedures and time charges
  • Ensure chargemaster accuracy through daily alerts on new coding changes, including interpretation and suggested actions for compliance by the nThrive clinical team
  • Gain insight from monthly CDM reviews, and compare your CDM to nThrive’s Preferred Practice Model to flag and resolve discrepancies
  • Automate manual processes, such as change requests, to keep your CDM up to date and synchronized across multiple facilities, and compliant with your corporate standard
  • Increase operational efficiency with integration on all leading patient accounting systems (PAS) 
  • Integrate supply and pharmacy costs, and optimize revenue capture and reimbursement to establish a defensible mark-up strategy. Address your regulatory questions through two convenient options: 1) Alerts for new informants that provide a summary of regulatory changes and a link to further documentation 2) Utilize Coach to ask questions and receive guidance from our clinical experts
Maricopa Medical Center gains net revenue improvement of $17.5 million with Patient Access and Charge, Pricing and Compliance Solutions

Maricopa Medical Center gains net revenue improvement of $17.5 million with Patient Access and Charge, Pricing and Compliance Solutions

nThrive helps Maricopa Medical Center update its chargemaster for accuracy and compliance, and improves revenue and enables defensible pricing

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Charge Capture Audit

Missing charges, over charges and coding errors can adversely impact your revenue and create significant compliance issues, including penalties for charge overages. If you take no action, you may find your health system struggling financially.

By automating audits for all your inpatient and outpatient charges, nThrive charge capture locates lost revenue from missed charges and coding errors, reduces the risk of billing overcharges, and identifies and fixes compliance issues pre-bill, preventing costly rework and late charges. nThrive technology and consulting services provide the insight to create sustainable process improvements so you can:

  • Increase average net revenue and identify millions in missed chargeswith nThrive’s comprehensive charge-level auditing, encompassing 12,000+ rules and predictive analytics
  • Ensure timely compliance on new regulations through nThrive’s credentialed team of clinical experts who analyze and deploy new auditing rules on effective dates
  • Avoid A/R delays with nThrive workflow processes that route exceptions to the best professional to resolve pre-bill issues based on your health system’s criteria
  • Overcome resource constraints and recover lost charges —pre-bill or post-bill — through outsourcing service from nThrive.
Gwinnett Hospital System identifies $16.3 million in net financial improvement

Gwinnett Hospital System identifies $16.3 million in net financial improvement

Using nThrive Charge Capture Audit solution, Gwinnett Medical Center improves its net revenue by $1 million in the first year, increasing to $16 million over time

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Phoebe Putney Memorial Hospital identifies $12 million in lost charges

Phoebe Putney Memorial Hospital identifies $12 million in lost charges

Using nThrive’s Charge Capture Audit solution, Phoebe Putney Memorial Hospital corrects 1,200 accounts and improves net revenue by $1 million in the first year

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Pricing

Price management and modeling are essential to revenue and cost recovery, competitive advantage, compliance on pricing transparency regulations and the ability to provide accurate estimates for consumers and patients.

nThrive’s modeling solution can help you achieve incremental net revenue to offset shortfalls brought about by APCs and removal of “non-covered” Medicare charges. Providing defensible pricing at the line item, department and facility level, and showing impact on managed care stop-loss contracts, empowers your organization to:

  • Use nThrive’s flexible modeling methodology to set multiple pricing parameters, deploy cost mark-ups and apply competitive rules at the CPT® and clinical service level
  • Gain a higher level of cost-to-pricing accuracy, and improve revenue through nThrive proprietary pricing benchmarks that include inpatient and outpatient services, supplies and drugs
  • Achieve incremental net revenue and realize returns of $300,000 to $5 million in incremental net revenue ‒ depending on hospital size, payer mix and pricing parameters – often with no overall hospital price increase.
Orlando Health Case Study

Orlando Health Case Study

Orlando Health Services improved their market position through strategic price increases using nThrive Defensible Price Modeling and achieved $12.9 million in net benefit over five years

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Healthcare pricing strategy: Where to begin

Healthcare pricing strategy: Where to begin

Read nThrive’s executive guide to learn how to identify key pricing objectives, define what to look for in a partner and determine modeling options.

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Charge Integrity Solutions