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Context 4 Healthcare, Inc. announces the latest addition to the Medicare pricing capability of the DecisionPoint Pricing System – Skilled Nursing Facility

  • by John Danza
  • Dec 5, 2016, 14:47 PM
DecisionPoint Pricing System
Context 4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the Skilled Nursing Facility Medicare Prospective Payment System (PPS) as the latest addition to Context’s DecisionPoint Pricing System™. This latest addition further expands the DecisionPoint Pricing System, 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.

DecisionPoint Pricing System also integrates Context’s industry-leading Usual, Customary & Reasonable (UCR) databases. This allows payers to use one solution for pricing claims using UCR, Medicare, or Medicare with gap fill using the UCR for the approximately 800 procedure codes not priced by Medicare. This level of flexibility in a single solution is not found anywhere else in the industry.

Mark Earles, CEO of Context 4 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 Context 4 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.

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