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Context4 Healthcare, Inc. announces the latest addition to the Medicare pricing capability of the DecisionPoint Pricing System – Home Health Agency

  • May 1, 2017, 09:51 AM

NAPERVILLE, Ill, (April 27, 2017) – Context4 Healthcare, Inc., a leading provider of healthcare compliance and pricing solutions, announces today the implementation of the Home Health Agency 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 proprietary logic combined with the various Medicare PPSs, DecisionPoint finds the correct Medicare fee for the services in the claim, all in real-time. Your system links to DecisionPoint through a simple web service interface, resulting in your system having the correct Medicare fee in a matter of a second. There are absolutely no instances where a claim might have to be manually priced. DecisionPoint can handle 100% of claims in real-time.

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

Mark Earles, CEO of Context4 Healthcare, stated: "The DecisionPoint Pricing System continues to show the advanced innovation from Context, bringing out solutions that are important to payers. 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. Payers have learned that they can rely on Context 4 Healthcare"

About Context4 Healthcare, Inc. Headquartered in Naperville, IL, Context4 Healthcare has nearly 30 years of experience in software and data product development. Context is a leading provider of healthcare compliance and reimbursement solutions including DecisionPoint™ Pricing System along with ClaimsEditor® and FirstPass™, both real-

time, online payment integrity solutions. These solutions serve hundreds of provider, health system, and payer clients, positively impacting millions of lives globally.