Public Sector

Hospital Reimbursement Modeling

The Reden & Anders Hospital Reimbursement Model provides employers with a powerful tool for evaluating varying reimbursement arrangements for inpatient hospital services.

The Hospital Reimbursement Model frees you from endless data overload by transforming data into timely information—information that is needed for business-critical decisions.

Simplify the inpatient facility contracting process

The model allows the user to evaluate the financial impact of different inpatient facility reimbursement arrangements such as per diems, per admission, diagnosis related groups (DRGs) or percent of charges discounts with associated outlier provisions.

Identify key drivers of inpatient reimbursement or expense

Run what-if analyses to assess the dollar impact of proposed changes in the reimbursement agreement:

  • What happens to my average reimbursement/expense per day if rates for medical and surgical days increase along with increases in the associated stop-loss deductibles?
  • What happens to my average reimbursement/expense per day if separate stop-loss provisions are proposed for cardiac DRGs?
  • What impact does paying 60% of charges for implantable devices have on my average reimbursement/expense per day?

Transform data into information to make business-critical decisions

After the specifics of the reimbursement arrangement are entered, the Reden & Anders Hospital Reimbursement Mode adjudicates a normative inpatient facility claims database using the entered reimbursement parameters. The impact of different reimbursement levels can be compared in aggregate or on a per day or per admission basis.

Flexible modeling tool

The Reden & Anders Hospital Reimbursement Model provides a flexible modeling tool for quickly converting the payment parameters of an inpatient hospital services contract to an equivalent per diem or per admission basis and handling a comprehensive array of inpatient payment provisions.