Enhance Accuracy, Efficiency, and Trust in Medical Device Billing
In the complex landscape of the medical device industry, precise billing is paramount. Accurate billing fosters healthy partnerships & ensures both medical device manufacturers and hospitals can effectively manage their finances. But it’s not easy.
Existing Challenges
The management of pricing construct data is fraught with challenges. Few, if any, systems simplify construct data management or automate the construct billing process. Construct data management is messy or non-existent, and the assignment and review of billing constructs typically requires manual intervention. Compounded, these issues result in losses of time, revenue, and trust—for both the medical device manufacturers and hospitals.
Exception Management
Often, manufacturers will manually apply and review billing constructs to procedures to ensure contract compliance. However, this process is prone to human error and drastically slows the order to cash cycle. Even if a manual review process is in place, poor data management and lack of automation results in a high volume of billing discrepancies. When processing hundreds or thousands of sales orders a day— annually, these discrepancies can total in the millions of dollars. Billing discrepancies are not only a financial detriment, but they also strain partnerships between device manufacturers and hospitals.
Dynamic Data
The primary challenge is the difficulty of accurately managing relevant data. Medical device pricing constructs require massive volumes of ever-changing data. A single medical device manufacturer often must manage hundreds of thousands of pricing constructs—if not millions!
Purpose-built Solution
What would the solution look like, given these challenges? It requires automation of manual effort, using analytical models and a new data schema.
Billing Construct Data Preparation & Management
Laying the groundwork for billing construct automation requires the design of a schema specifically for pricing construct data. This standardized structure promotes accurate visibility and enables ease of management. Accuracy and ease of maintaining pricing construct data are the crucial first steps needed before any benefits of automation can be seen.
Model for Recommending Contract-Compliant Billing Constructs
Creation of a standardized data schema lays the foundation from which to then leverage advanced analytical models. Using these tools, developing automations enables users to seamlessly apply the best constructs to a case. After usage is added to a case within the automated application, users generate a set of recommended constructs that leverages the defined analytic models. From there, the best constructs are applied to each case, driving contract compliance. This process is repeated as needed for any additional usage added to cases after constructs have already been applied. The model developed provides recommendations of varying complexity—a recommendation can range from a single construct up to as many as needed to capture the sophistication of the given case usage.
Figure 1: Model for Recommending Contract-Compliant Billing Constructs
Moving Forward
This model is the future of construct billing in the healthcare space. Sales reps no longer need to manually figure out which billing constructs are needed for a case, and sales order processing no longer needs to be delayed for manual validation every time a construct is used. Most importantly, poor practices in construct billing will no longer cause millions of dollars in billing discrepancies. This state-change serves to bolster partnerships in the healthcare space.
Going beyond automation, this solution offers valuable insights into how organizations can best structure and maintain their construct pricing data. Automated construct billing minimizes the risk of human error. This, in turn, ensures that medical device manufacturers are appropriately compensated and that hospital partners are not billed erroneously for contracted goods & procedures. Advanced capabilities include aligning Supplier Constructs with the contracted “Cap” pricing which exists in the Hospital’s Item Master. This improves transactability of a manufacturer with hospital customers.
Acting on the Opportunity
Seeing this shared difficulty as an opportunity to promote data-driven decision making & automation, Movemedical set out to develop this precise described solution.
Why Movemedical Makes Sense
Movemedical’s automated billing construct feature is at the forefront of billing accuracy and efficiency in the medical device space. Users can simply add usage to a case & the model will generate a set of the best billing constructs to apply. This automation guarantees contract compliance, reduces the risk of human error, and streamlines the billing processes. Using this system, both medical device manufacturers & hospitals learn to trust the construct billing process. Constructs are accurately assigned, and the risk of costly discrepancies is reduced, fostering a trusting partnership between all stakeholders involved.
Conclusion
In medical device billing and construct pricing, innovation is paramount to addressing the persistent challenges of accuracy, efficiency, and trust. Movemedical is revolutionizing how medical device manufacturers and hospitals interact in the billing ecosystem. Our commitment to this transformation extends beyond providing smart automation via platform features. We aim to be the thought leader and partner of choice for all organizations in the healthcare space, offering a holistic approach to construct pricing management.
If automating your construct pricing processes makes sense for your business, let’s have a conversation about it:
info@movemedical.com / call 877.469.3992
or watch this VIDEO (executive case study)
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