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The CDM FOCUS™ Comparative Pricing Module is a web-based, outpatient
database utilizing the latest Outpatient Prospective Payment System (OPPS) data
supplied by CMS. We provide a number of data integrity edits including the
removal of any records with less than $1 (one dollar) in charges for any given
procedure. This ensures that average cost or charge calculations are not skewed
downward due to bad data or missing charges. Additionally, we offer all
comparative cost and charge reports with and without a one or two standard
deviation threshold for the calculation of the mean charge and cost by HCPCS
code. This provides users with an additional mechanism to remove outliers from
the mean calculations further improving the integrity of the data used in
assessing your organization’s relative price and cost position in the market. |
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Identify how a hospital’s outpatient prices and frequency compares with its
competitors or selected peer groups at the HCPCS level (15 to 30% of a typical
hospital's net revenue is paid on the basis of charges).
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Identify how a hospital's outpatient costs compare with its competitors or
selected peer groups also at the HCPCS level.
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Determine how a hospital’s current charge mark-up factor compares to the
mark-up factor of its competitors or selected peer group(s).
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Negotiate managed care contracts from a position of strength and knowledge by
understanding your hospital’s price competitiveness/cost efficiency as compared
to other area hospitals (overall and by procedure).
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Establish prices for new procedures/programmatic development.
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Establish price thresholds prior to implementation of a strategic pricing
initiative at the hospital.
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Monitor pricing and Medicare outpatient activity via the web and rerun reports
as updates are received from CMS.
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Once "logged-in" you will be able to select a (customer) hospital
and to create your own customized peer group. You will then be able to view or
print comparative charge, cost and charge-to-cost mark-up factor reports for up
to 5 randomly selected HCPCS codes and 2 departments. If after you test the
system and you decide to become a full subscriber you will be entitled to run
unlimited comparative reports for unlimited customized peer groups for ALL
HCPCS codes. Moreover, each time we update our database, with more current
claims information, you will have access to that information for no additional
charge.
Click here to
register for your FREE Trial, or click here to
login if you have already registered.
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Comparative Charge Reports – These reports compare
a hospital’s average or mean charge per HCPCS code to that of any customized
peer group selected from a database of over 5,000 providers. A report
illustrating the detail for each hospital contained in the comparative group
can then also be produced. Frequency statistics by HCPCS code are also provided
for each hospital along with hospital name(s).
Comparative Cost Reports - These reports compare a hospital’s
average or mean cost per HCPCS code to that of any customized peer group
selected from a database of over 5,000 providers. A report illustrating the
detail for each hospital contained in the comparative group can then also be
produced. Frequency statistics by HCPCS code are also provided for each
hospital along with hospital name(s).
Comparative Mark-up Reports – These reports compare a
hospital’s average or mean mark-up of its charges over cost for each HCPCS code
to your customized peer group selected from a database of over 5,000 providers.
A report illustrating the detail for each hospital contained in the comparative
group can also be produced along with frequency statistics and hospital names.
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COME VISIT US
HIMSS Annual Conference & Exhibition
February 25 – March 1 | New Orleans, LA | Booth 2663
Comparative Pricing UPDATED WITH 2006 DATA 11/14/2007
The CDM Focus Comparative Pricing module has recently been updated with 2006 UB Data, Volume, HCPCS Codes, and Standard Deviation Schedules. As of 11/14/07 all reports are running against the OPPS dataset from July 1, 2006 – December 31, 2006.
Innovative Health Solutions Enters Into Strategic Alliance With 3M Health Information Systems 2/7/2006
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CDM FOCUS™ UPDATED FOR JAN 1, 2006 CODE CHANGES: 12/7/2005
CDM FOCUS Compliance Module has been updated with the CMS Outpatient Prospective Payment Systems (OPPS) CY 2006 changes as well as the CPT/HCPCS changes that are effective as of January 1, 2006. New reports have been added for CDM Focus subscribers to reflect these changes, and existing reports have been updated with the new information.
In the final rule, CMS has added almost 600 new CPT/HCPCS codes, and deleted approximately 400 codes. An additional 700 codes have been changed either APC assignment or Status Indicator. Where appropriate, replacement codes or alternate codes have been assigned, as have revenue codes and standard departments. New links have also been added to the C Code Device Dependent report effective January 1, 2006.
Comparative Pricing UPDATED WITH 2004 DATA11/3/2005
The CDM Focus Comparative Pricing module has recently been updated with 2004 UB Data, Volume, HCPCS Codes, and Standard Deviation Schedules. As of 11/3/05 all reports are running against the OPPS dataset from July 1, 2004 – December 31, 2004.
ACCURO HEALTHCARE SOLUTIONS ACQUIRES INNOVATIVE HEALTH SOLUTIONS - “Best in Class” Coding and Reimbursement Management Services Added to Accuro’s Existing Product Offerings 10/18/2005
(Read More)
CDM FOCUS UPDATED FOR JULY 1, 2005 CODE CHANGES:6/21/2005
Effective July 1, 2005, CMS has posted a revised Addendum A and Addendum B on the hospital outpatient prospective payment system website to reflect quarterly changes in the OPPS. These changes have been incorporated into CDM Focus including:
- Payment for drugs based on the Average Sales Price (ASP) has been updated, and correction has been made for payment of Adalimumab.
- Codes for newly approved drugs have been added.
- A national Coverage Determination (NCD) on January 28, 2005 approved coverage of off-label used of specific anti-cancer drugs furnished during clinical trials. The drugs include oxaliplatin (Eloxatin), irinotecan (Camptosar), cetuximab (Erbitux), or bevacizumaab (Avastin), and are represented with codes J9035, J9055, J9206, J9263, J8520, J8521, J9201 and J9190.
- A new modifier, QR must be added to identify "non-routine" costs of these 9 clinical trials, including the administration costs of the items/services/drugs provided in the clinical trials that are not generally covered.
- The device dependent CPT/HCPCS procedure codes have been updated with the tables for the October, 2005 edits.
PRESS RELEASE:4/10/2005Innovative Health Solutions and MediRegs Develop New Knowledge Based Regulatory and Reimbursement ProductInnovative Health Solutions CDM FOCUS Pricing Systems First to Recieve Distinguished "Peer Reviewed" Designation by HFMACDM FOCUS UPDATED FOR APRIL 1, 2005 CODE CHANGES4/9/2005Effective April 1, 2005, CMS has posted a revised Addendum A and Addendum B on the hospital outpatient prospective payment system website to reflect quarterly changes in the OPPS. These changes have been incorporated into CDM Focus including:
- The codes associated with the new Status Indicator M, Services not billable to the fiscal intermediary and not payable under the OPPS, have been identified. A new report has been added to CDM FOCUS to identify services with this new non-reportable payment status.
- Payment for drugs based on the Average Sales Price (ASP) has been updated, and corrections have been made to some misclassified drugs.
Existing codes for PET scans are being deleted effective April 1, 2005. The Level I replacement codes were effective January 30, 2005. Comparative Pricing UPDATED WITH 2003 DATA3/1/2005The CDM Focus Comparative Pricing module has recently been updated with 2003 UB Data, HCPCS Codes, and Standard Deviation Schedules. As of 12/22/04 all reports are running against the 2003 data.
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