October 31, 2023

One of the biggest financial challenges for hospitals today is effectively managing their revenue cycle. Healthcare providers are struggling with high labor costs, inflation in the prices of drugs and equipment, and the lingering financial fallout from the pandemic.

Additionally, hospital price transparency regulations require hospitals to publicly post various “standard charges” — including gross charges, discounted cash prices and payor-specific negotiated rates. Health plans face their own federal price transparency mandates through the Transparency in Coverage (TiC) rule and publish their negotiated payment arrangements with providers. Unfortunately, payors are also using this public data against providers during reimbursement negotiations.

To round out the fiscal challenges, the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) continually issue changes to HCPCS and CPT® codes that require hospitals to update their chargemasters to manage accurate billing and reimbursement.

These challenges underline the importance of hospital revenue integrity — ensuring your organization captures all available revenue while being transparent and competitive, and generating a positive margin. They also introduce pressures on accurate and compliant pricing:

  • If you don’t have a complete and compliant charge description master (CDM), you’ll miss out on revenue.
  • With prices now available to consumers and competitors alike, a rational pricing structure is a necessity to avoid bad publicity and maximize revenue.
  • Contracts with payors are increasingly moving toward value-based arrangements or other alternative, bundled payments that introduce financial risks to hospitals and put the onus on getting pricing correct.
  • Finally, you need strategic alignment between various stakeholders, from the CFO who focuses on meeting budget targets to department leaders and physicians who have regular interactions with patients and are susceptible to direct complaints about high costs.

This is why we developed the Trisus® Pricing Integrity Suite.

Comprehensive revenue cycle management intelligence

 Trisus is our award-winning, cloud-based platform of integrated and complementary solutions. It harnesses data from across your organization, refines it, and turns it into powerful insights you can use to help navigate the complex business challenges of modern healthcare.

Trisus Pricing Integrity offers benefits including automating key processes to increase productivity and decrease errors, reducing compliance risks, analyzing pricing market competitiveness, complying with Price Transparency regulations, and greater collaboration between clinical and business areas.

The Suite includes:

  • Trisus Chargemaster, our best-in-KLAS® award-winning automated management solution that increases efficiency in workflows, collaboration, and communication
  • Trisus Reference, a comprehensive list of clinical, financial, and regulatory coding information
  • Trisus Pricing Analyzer, automates price modeling while ensuring your pricing is defensible, transparent, competitive, and improves net revenue
  • Trisus Pricing Transparency, helps you comply with federal price transparency requirements
  • Professional Services and Support, provides access to The Craneware Group’s diverse expertise to help providers solve their biggest challenges

It's all available from a single platform — what we call the Power of One.

Visit The Craneware Group for more information and learn how we are transforming the business of healthcare.