NAPERVILLE, Ill, (September 12, 2016) – Context4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the End Stage Renal Disease Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. The DecisionPoint Pricing System is the first solution in the healthcare industry to provide automated, real-time access to accurate Medicare fees for pricing healthcare claims during adjudication.
When health plans adopt Medicare referenced-based pricing, they frequently don’t recognize the level of complexity that this decision brings with it. Medicare isn’t just a fee schedule. It’s a complex combination of pricing models for a variety of healthcare services, all requiring their own calculation algorithms for accurately arriving at a fee.
DecisionPoint Pricing System is the solution to that complexity. Using a proprietary logic base combined with the various Medicare PPSs, DecisionPoint finds the correct Medicare fee for the services in the claim in real-time. Your system links to DecisionPoint through a web service interface, resulting in your system having the correct Medicare fee in real time.
In addition to fully automated Medicare fee access, DecisionPoint Pricing System also integrates Context’s industry-leading Usual, Customary & Reasonable (UCR) databases. Combining full, accurate Medicare fees with Context’s UCR provides a powerful “gap fill” capability for the approximately 800 procedure codes not priced by Medicare.
Mark Earles, CEO of Context4 Healthcare, stated: “I’m excited about the pricing capabilities we’ve been able to bring to healthcare payers with the DecisionPoint Pricing System. With the financial pressures on payers today, they need to know that they’re accurately calculating their plan liabilities in a way that leverages today’s technologies. It’s the kind of innovation that our payer partners have come to expect from Context.“
About Context4 Healthcare, Inc.
Headquartered in Naperville, IL, Context4 Healthcare has more than 25 years of experience in software and data product development. Context is a leading provider of healthcare compliance and reimbursement solutions including DecisionPoint™ Health Payment System of Usual, Customary & Reasonable (UCR) fee schedules, and ClaimsEditor® and FirstPass™, both real-time, online claims editing solutions. These solutions serve hundreds of provider, health system, and payer clients, positively impacting millions of lives globally. www.context4.com