How Accurate Pricing & Coding Dramatically Improve Reimbursement Revenue

January 12, 2023
2 Minute Read

With healthcare organizations managing thousands of billing codes, it’s no surprise that 80% of medical bills contain errors. In many cases, these errors are honest mistakes because of a lack of data, fear of over or under coding, the organization misunderstanding its pricing strategies—or not having any at all. But the impact is real.

Coding and billing errors result in overcharging patients and employers, increasing claim denials, delaying or lessening reimbursement revenue and creating significant stress and wasted time for everyone involved in the payment cycle. Smarter revenue cycle management strategies can help healthcare organizations avoid these costly billing errors while implementing more accurate pricing and increasing reimbursements.

Getting pricing and coding right is acutely important as the cost of healthcare in the U.S. continues to climb, with national healthcare spending projected to reach a staggering $6.2 trillion by 2028 (CMS1). Even more concerning, the National Healthcare Anti-Fraud Association estimates that 3-10% of these costs are fraudulent—totaling as much as $230 billion annually.

This increased spending results in higher insurance premiums for consumers and employers, losses for providers and payers due to audits and inaccurate medical coding, and reductions in reimbursements and/or denial of coverage.

Compliant Coding Doesn’t Equal Lower Reimbursement: A Discussion About Healthcare Pricing and Coding

RGP Healthcare’s David Hullum and Kathleen Eagan recently presented a webinar highlighting how organizations can overcome these challenges to maximize revenue billing and collection.

Watch the replay for useful guidance on competitive pricing techniques and coding strategies, including:

  • The importance of price setting, price maintenance, and aligning price transparency
  • Practical cost-gathering strategies and why this is critical
  • Effective pricing techniques and strategies
  • Identifying the data to use and the importance of continuous monitoring
  • Why ongoing monthly coding audits and reviews are critical to maximize revenue
  • Why your organization needs a feedback loop to drive change

Want more info? Just ask:

Watch the replay of the webinar »

Revenue cycle management holds the key to lost patient revenue.

RGP’s Healthcare team can help you implement an effective and compliant pricing and coding structure that can have a significant impact on your bottom line. We can also help you find lost patient revenue by analyzing your clinical documentation, medical coding, billing and payment data, and using advanced analytics to identify and capture patient revenue opportunities.

1 The Office of the Actuary at the Centers for Medicare and Medicaid Service (CMS)

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