Client background 

A single-site hospital with approximately 200 beds that is looking to build an additional campus in Texas. 

The business challenge 

After implementing Epic Systems more than 15 years ago, the new CFO observed that the hospital had been undercharging medications for some payers related to 340B compliance. As a temporary response, a unique markup table was put in place and used for payers observed as undercharged. To address these concerns and provide a permanent solution, the client contacted Baker Tilly to:  

• Evaluate their current pricing structure using six months’ detailed claims. 
• Evaluate compliance for state and federal requirements (example appropriate modifiers) 
• Streamline medication billing to consistent pricing tables regardless of payer by removing the unique 340B medication charge table put in place as a stopgap for undercharging. 
• Remain gross charge neutral after moving to consistent charge tables without exceeding commercial contract caps 

Baker Tilly solution-driven approach 

After a thorough assessment of their electronic health records (EHR) build and claim details, Baker Tilly identified opportunities to update the build to meet the client's initial request. Baker Tilly also provided a unique dynamic tool using client-specific medication usage and payers. The tool allowed revenue leadership to immediately visualize and project the impact of changes to markup tables based on medication and payor and implement strategic pricing to improve ROI.  

The accomplished results 

Baker Tilly was able to ensure all payers were charged consistently with appropriate modifiers and improve 340B program compliance. In addition, Baker Tilly using strategic modeling tools helped the client identify an additional $11.3 million in annual gross charges with significant anticipated increase in claims paid.