Avoiding revenue loss due to 'lesser of' contract clauses
Stodolak, F.; Gutierrez, H.
Healthcare Financial Management Journal of the Healthcare Financial Management Association 68(8): 74-78
2014
ISSN/ISBN: 0735-0732 PMID: 25145034 Document Number: 675390
Finance managers seeking to avoid lost revenue attributable to lesser-of-charge-or-fixed-fee (lesser-of) clauses in their contracts should: Identify payer contracts that contain lesser-of clauses. Prepare lesser-of lost-revenue reports for non-bundled and bundled rates. For claims with covered charges below the bundled rate, identify service codes associated with the greatest proportion of total gross revenue and determine new, higher charge levels for those codes. Establish an approach for setting charges for non-bundled fee schedules to address lost-revenue-related issues. Incorporate changes into overall strategic or hospital zero-based pricing modeling and parameters.