Healthcare Custom Pricing Projects

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Your Vision, Executed: Custom Pricing Projects for Complex Challenges

Not every Charge Description Master (CDM) challenge fits into a neat box. Mergers and acquisitions create standardization nightmares. Pharmacy billing requires specialized knowledge. Supply chain revenue integrity is a moving target. When your organization faces a complex CDM project that goes beyond routine maintenance, you need a partner with the flexibility and expertise to deliver a custom-fit solution.

Combine a goal-oriented approach with deep industry knowledge to tackle your most difficult challenges.
Ensure optimal results that save time, enhance compliance, and drive millions to your bottom line.
Meet your unique needs and strategic goals.

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The High Stakes of Pricing in the Dark

Standard software and routine audits are excellent for day-to-day CDM management. But they are not designed to handle large-scale, transformative projects. Your health system is a dynamic entity with specific strategic objectives, legacy systems, and unique market pressures.

Applying a generic solution to a custom problem leads to:

Wasted Resources: Time and money spent trying to force a standard tool to perform a non-standard task.
Incomplete Results: The core issue is patched over but not truly solved, leading to recurring problems.
Operational Disruption: A one-size-fits-all approach clashes with your established workflows and staff expertise.

Custom Pricing Projects are the answer when you need to align your revenue cycle infrastructure with a major strategic initiative. Whether it’s standardization post-merger, a full pharmacy formulary review, or a supply chain overhaul, a tailored project ensures the outcome perfectly matches the objective.

CDMs Aren’t One-Size-Fits-All: Customize to Meet Your Needs

CDM Standardization and Compliance

CDM standardization is one of the most complex projects a health system can undertake. This is especially true when facilities operate on different EMR platforms, separate instances of the same system, or have wildly misaligned charge structures. These inconsistencies create significant revenue management challenges, compliance risks, and operational inefficiencies that are impossible to ignore.

A properly developed and implemented standardized CDM is not just a “clean-up” project; it is a fundamental business transformation that delivers measurable improvements across the board.

Improved Revenue Management

A standardized charge structure is the bedrock of accurate APC monitoring, CPT-4 coding, and defensible price-setting. It dramatically reduces compliance risks associated with inconsistent billing practices across facilities.

Enhanced Insights

When charges are consistent, you can finally compare apples to apples. A standardized CDM improves clinical activity tracking for decision support systems, enabling more meaningful comparisons between facilities and more precise costing of hospital services.

Streamlined Charge Capture

Standardization extends beyond charge codes to input sources, update policies, and ongoing CDM maintenance protocols. This eliminates departmental duplication of effort, increases efficiency, and enhances revenue capture across all facilities in your system.

Operational Alignment

The end goal is powerful simplicity. Hospitals transition to a unified CDM and standardized pricing—either fully aligned or within an acceptable range based on financial directives—ensuring total consistency across the health system.

Pharmacy Billing and Revenue Integrity

Pharmacy billing is a world of its own, governed by complex coding, intricate reimbursement rules, and massive data sets. Errors in the pharmacy chargemaster can lead to millions in lost revenue and significant compliance exposure. PMMC specializes in custom projects focused on every aspect of pharmacy revenue integrity.

Comprehensive Auditing

We conduct deep-dive audits of pharmacy revenue integrity data within both your formulary and patient accounting systems. Our experts ensure accurate coding (HCPCS, HCPCS units, and Revenue Codes) that precisely reflects the medications dispensed. We verify that National Drug Code (NDC) information aligns with your organization’s purchases, confirm appropriate markup category assignments, and ensure seamless interfacing of drug records with patient accounting systems.

Strategic Markup Development

Beyond auditing, PMMC assists clients in developing industry best-practice markup strategies for pharmaceuticals. This is not just about setting prices; it is about building a logical, defensible, and sustainable methodology. This includes establishing charge protocols for:

Markup category assignments and classifications.
Handling self-administered drugs.
Evaluating cost bases and creating maintenance and reconciliation processes.
Aiding in system migrations and conducting internal audits.

Supply Chain Billing Optimization

Supply chain billing presents a complex set of challenges for any health system. It is often marked by vague compliance rules and complex managed care agreements that include carve-outs and distinct payment terms for various implants and high-cost supplies. CPT and revenue coding are crucial for proper reimbursement, but the revenue integrity data is typically dispersed across multiple systems, from the Material Masterfile to the patient accounting system itself.

PMMC’s experts have the knowledge and capacity to unify this disparate data and build a compliant, high-performing revenue process.

Holistic System Review

We review data across all relevant systems to build a single source of truth for supply chain billing.

Strategic Guidance

PMMC offers deep expertise in refining supply markup formulas, determining the billing eligibility for supplies, and distinguishing between implants and non-implants – a critical factor for reimbursement.

Process Development

We assist in developing robust charge and maintenance protocols, estimating potential revenue enhancements, and providing industry best practices for supply pricing.

One-Time Supply Management

PMMC evaluates and improves processes for one-time or special-order supplies, ensuring accurate charge entry, appropriate markup application, correct coding, and proper invoice documentation.

Implementation & Education

When necessary, we develop charging tools, create educational resources on coding best practices for staff, assist with system transitions, implement changes, and monitor results for continuous improvement.

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Aligning Project Outcomes with Your Strategic Objectives

A custom project is only successful if it helps you achieve a larger business goal. We begin every engagement by working closely with your team to understand what success looks like for you. We work closely with your team to align every project outcome with your strategic objectives, helping you achieve measurable success that resonates all the way to the executive level.

Are you acquiring a new hospital?
Our goal will be to standardize the CDMs with minimal disruption and maximum revenue synergy.

Are you concerned about pharmacy compliance?
Our goal will be to create an ironclad, auditable process that maximizes reimbursement.

Are you launching a new service line?
Our goal will be to build the CDM structure correctly from day one.

Enhanced Benefits of Custom CDM Projects

The one constant in healthcare is change. Your organization will grow, acquire new entities, and face evolving challenges. Custom projects are designed with this future in mind.

Custom projects are an investment, and we design them to deliver a clear return. By addressing your specific needs with a precisely targeted solution, we help you streamline processes, save time, and optimize the resources within your organization.

Adaptability

Our solutions are not rigid. We build processes and structures that can adapt to changing regulations or business needs.

Scalability

We design solutions that can support your organization as it grows. A standardization project for two hospitals can be built to scale easily to ten.

Future-Proofing

By addressing foundational issues in your CDM, we help future-proof your revenue cycle against tomorrow’s challenges.

Eliminate Rework

A custom-built solution solves the problem correctly the first time, eliminating the need for future patches and fixes.

Free Up Internal Teams

By outsourcing a complex, one-time project to our experts, you allow your internal team to stay focused on their critical day-to-day responsibilities.

Faster Results

Our experienced team can execute complex projects more quickly and efficiently than an internal team learning as they go, accelerating your time-to-value.

A Partnership Built on Collaboration

We believe the best results come from a true partnership. A custom project is not something we do to you; it is something we do with you. We foster open communication and collaboration at every stage, ensuring your team’s input and institutional knowledge guide the project for the best possible outcome.

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Joint Planning Sessions: We kick off with intensive discovery sessions to ensure we understand your goals, constraints, and systems.

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Regular Check-ins: You are never in the dark. We provide consistent updates and progress reports.

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Knowledge Transfer: Our goal is to leave your team stronger than we found them. We provide documentation, training, and support to ensure you can maintain the solution long after the project is complete.

Partners in your Success

A successful custom project hinges on the quality of the people executing it. When you partner with PMMC, you gain access to a team of seasoned experts who bring extensive knowledge and years of hands-on experience to your project.

Our team’s expertise spans:

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Revenue Cycle Management: From billing and coding to managed care contracting.

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Clinical Operations: We have former nurses and department managers who understand clinical workflows.

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Healthcare IT: We have experts in all major EMR and patient accounting systems.

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Regulatory Compliance: We are students of the ever-changing rules governing healthcare reimbursement.

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Advanced Analytics & Reporting

Data is the backbone of any successful project. PMMC’s Analytics+ provides complete transparency throughout the project and delivers actionable insights upon completion.

Tailored to Your Needs: Reporting and analytics are customized to the specific goals of the project. You get the data you need, not a generic dashboard.
Empower Your Teams: We give your teams the information they need so they’re prepared to manage and sustain the results.
Drill-Down Capabilities: Our platform allows you to query detailed data, create custom dashboards, and drill through from a high-level summary report to the relevant line-item detail. This is critical for validating results and investigating anomalies.

Let's Build the Solution Together.

Stop trying to fit your unique challenges into a standard-sized box. Partner with PMMC to design and execute a Custom Pricing Project that delivers on your strategic vision and produces measurable financial and operational results.

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Custom Pricing Projects