How does cost-based pricing work?
If your plan language will allow replacement of charge-based UCR maximums with a cost-based methodology, HRGi can price your claims according to CMS protocols and apply your determined percentile limitation. For example, you may decide that 200 percent of APC Pricing will mark the maximum allowable payment for outpatient facility procedures. HRGi can reprice claims according to CMS guidelines for most inpatient and outpatient facility claims including DRG, APC, and ASC pricing methodologies. We’ll also apply your maximum allowable multiplier per your selected guidelines.
