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Dear Colleagues,

Hospital Pricing Specialists recently updated its database of hospital machine-readable pricing files to analyze the full claim charge (not just the line-item price) for CPT 19120 - Excision of Cyst.

Note:  only hospitals in compliance with the new rule that requires the charge of ancillary items and services that customarily occur with the primary shoppable service are included:



This means that the customary ancillary charges must be LINKED to the primary service.  Simply including all of the ancillary charges in a non-linked chargemaster is not compliant.  

Among the hospitals that provided a compliant machine-readable file, HPS found that for CPT 19120 - Excision of Cyst, the average claim charge among California hospitals is $21,183, consisting of an Operating Room + Procedure Charge of $17,220, Laboratory charge of $1,395, Pharmacy charge of $1,462, and Supply charge of $73. California's average total claim charge for CPT 19120 is four (4) times higher than what Montana hospitals charge. [Click Here] to see full report.



Besides calculating full claim-level charges for outpatient surgeries, HPS's artificial intelligence and deep machine learning algorithms are able to calculate the payer negotiated rate for the entire outpatient surgery.  In addition, HPS applies its patent-pending outpatient case mix index to normalize costs and payments across hospitals.

If you have any questions, feel free to schedule a time to talk on my private calendar:  go.oncehub.com/ricklouie


Regards,

Rick Louie
Managing Director
Hospital Pricing Specialists LLC

LinkedIn Profile:  https://www.linkedin.com/in/ricklouie/

Watch video of Shark Tank's Mr. Wonderful endorsing HPS Price Transparency services [Click Here]



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