Hospital Pricing Specialists is a specialized data analytics company that helps hospitals with revenue cycle management, pricing transparency and payer negotiations.

Silicon Valley, CA–(Newsfile Corp. – October 11, 2024) – Founded in 2012, Hospital Pricing Specialists (HPS) has become an indispensable player in helping hospitals across the United States navigate the complexities of revenue cycle management , price transparency and negotiations with the payer. Led by Rick Louie, CEO and Founder, the company has served as a data analytics company specializing in optimizing hospital pricing and creating comprehensive solutions for hospitals to meet now demanding transparency regulations prices from CMS (Centers for Medicare & Medicaid Services).

Hospital Pricing Specialists

HPS focuses on assisting hospitals with their revenue cycle, the financial process that involves managing the flow of money from patient care services to final payments. By leveraging their extensive database of hospital pricing information and payer rates, these healthcare company data analytics help hospitals optimize their pricing strategies, ensuring they are competitive in their market and compliant with CMS regulations.

Rick explains, “We collect and analyze two basic sets of data: gross rates or list price for each service and payment rates from various insurance companies. This allows us to conduct in-depth pricing studies for hospitals , compare their prices with those of competitors, and help them align their pricing models to optimize their revenue. In doing so, we ensure that hospitals do not leave money on the table and are reimbursed appropriately by. insurers.

With more than 1,200 successful pricing projects, HPS’s ability to use data is one of its greatest strengths. The company acquires publicly available claims data from hospitals across the United States, creating a rich database that captures both pricing and rate information from payers. This data is then used to help hospitals conduct pricing studies, compare their services to those of local competitors, and adjust their prices to remain competitive.

The CEO explains with an example: “In many hospital contracts, reimbursement is based on a percentage of the hospital’s gross price. For example, if a hospital charges $1,000 for a service and a competitor charges $2,000 for the same service, the hospital could lose significant revenue because they are reimbursed a lower percentage of their costs. Through our pricing studies, we help hospitals adjust these prices to optimize revenue, ensuring prices are consistent with current market levels while not exceeding payer increase thresholds.

In addition to price optimization, HPS plays a critical role in assisting hospitals in negotiations with payers. Given the complex mix of contracts between hospitals and insurers, in which services can be reimbursed under different models – such as fee-for-service, percentage charge or per-case rates – HPS has partnered with DeducibleData to create a comprehensive payer database. rates to provide hospitals with valuable information. Rick explains, “Each payer has a different way of reimbursing hospitals, and these methods can vary greatly depending on the service provided. By comparing a hospital’s payer contracts with those of its competitors, we provide actionable data that hospitals can use in negotiations to obtain better reimbursement rates. , demonstrating the value they bring to insurers.

Since 2019, hospitals have faced increasingly strict regulations under CMS’s price transparency rules. Hospitals are required to post their prices online and provide a tool to help patients estimate their out-of-pocket costs. This transparency aims to empower patients, allowing them to make more informed decisions about their healthcare.

Rick highlights HPS’s role in this evolving landscape: “We offer a fully outsourced solution that helps hospitals comply with CMS transparency requirements. Our flagship tool, EZCOST(R), simplifies the price transparency process by providing an easy-to-use cost estimator. for patients. We also ensure hospitals have compliant, machine-readable files of their contracted rates, so they can avoid financial penalties for non-compliance.

HPS works with hundreds of hospitals across the country, helping them meet these critical transparency requirements. By providing tools that meet these complex regulations, HPS enables hospitals to not only meet their legal obligations, but also improve their relationships with patients, providing them with clear and understandable pricing information.

Rick’s experience in the healthcare industry spans over 25 years. Prior to founding HPS in 2012, Louie was involved in several successful startups, including one focused on health IT and benchmarking pricing for major U.S. automakers. His deep expertise in healthcare pricing and reimbursement, combined with his experience in business intelligence and consulting, has positioned HPS as a leader in the field. “Our mission”, underlines the founder, “is to guarantee that hospitals are reimbursed fairly and transparent on their prices, which ultimately benefits both the hospital and the patient.”

HPS offers a full range of services beyond its EZCOST(R), designed to meet the pricing, reimbursement and compliance needs of hospitals. These include MOAD(R), a machine-readable file tool for contracted rate data required by CMS; Transparent Pricing Review (TPR), which ensures defensible and competitive pricing strategies; Comprehensive Chargemaster Review, which maintains accurate hospital rates for better reimbursement; and Payer Market Analysis (PMA), a reporting tool that analyzes for a specific payer where a hospital’s rates compare to those of its competitors to better understand which services to preserve or negotiate better rates. Through these products, HPS not only helps hospitals optimize pricing and reimbursement, but also ensures they remain competitive and compliant in today’s complex healthcare environment.

As price transparency laws continue to evolve, the need for accurate pricing data and compliant solutions will only increase. Hospital Pricing Specialists is well-positioned to meet these challenges head-on, providing hospitals with the tools they need to thrive in this new era of healthcare transparency.

“We’ve built a company that hospitals can trust to deliver results,” says Rick. “With more than 60 years of combined senior leadership expertise and a proven track record, we are excited to continue helping hospitals navigate the complexities of the healthcare system and ensure hospitals and patients get value that they deserve.

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