FINANCIAL: Quest Precision Pricing Software:

• Will generate additional net revenue.
• Will allow a hospital to provide immediate payer-specific, price-quotes.
• Will remain gross revenue neutral…. while adding net revenue.
• Will not affect standard Medicare or Medicaid reimbursement.
• Will reduce contractual allowances.
• Will not require additional FTE’s.
• Will require NO capital outlay.
• Will VALIDATE net revenue enhancement within 48 hours of receipt of a hospital's data.
  

Quest Pricing Software is not a generic product. Hospital-specific CDM pricing modifiers are established from each hospital’s CMS cost reports, case & payor mix trends, MSA and other data.  Inpatient indexes are based on DRG assignment and outpatient indexes are based on revenue code.  Quest software applies the same logic as the Medicare relative weight model, in use by CMS since 1986, applying severity of illness and the delivery site of service as compliant components of ALL patient treatment.

COMPLIANCE:

• CMS / HIPAA / OIG
• Original CMS written acknowledgement received in 1994.
• Maintains current HIPAA compliance agreement with all clients.
• 17 years of “unqualified audits” by CMS & clients CPA.
• Has accurately handled over $27 billion in patient charges.
• 2003, 2007 and 2008 independent legal opinions affirming compliance.
• Never requires any patient identifying information.
• Recommended by the Hospital Associations in Texas, Mississippi and Florida.

OPERATIONAL:

• Fully automated and electronic.
• Utilizes an HL-7 interface.
• Hospital’s internal data is secure from outside access.
• No change to the hospital’s charge master.
• Automatically reconciles general ledger after applying indexing.
• No lost time in billing cycle.
• All Interface-related expenses paid by Quest.
• Uniform, fair, ethical and compliant pricing.

The Quest System is a hospital-specific pricing program, operating automatically at the end of the billing cycle. It allows hospitals to reduce how much they increase patient charges annually while improving their cash flow.

Quest uses hospital-specific statistical analysis and indexing to enable hospitals to adjust charges at the time of billing. By reducing statistically over-priced items that result in contractual allowances, and increasing statistically under-priced items that increase overall cash flow, Quest allows a hospital to charge less and bank more.

With the growth of consumer driven health plans, this product is a very timely tool that hospitals can use to reduce the amount that they need to raise their charges annually to keep up with costs. The hospital will see a reduction in contractual allowances of between five and thirty percent, and an increase in cash of between $100 and $200 per case. This means a hospital no longer has to implement large across-the-board price increases, so employers and managed care plans will experience a moderation in annual hospital price adjustments.

Quest is a copyrighted precision pricing and budgeting system that delivers more effective unit pricing results while meeting all current CMS, IRS, OIG and HIPAA requirements. Through site of delivery analysis, the System finds the "best" unit prices which are realized through individually-developed hospital-specific price indexes. For inpatients, there is an index for each DRG Number; for outpatients, for each revenue code. Each price index is uniformly applied to each unit price and to each payer within the same DRG or revenue code.

Hospital-specific pricing indexes are developed when the hospital submits twelve months of combined financial class data – patient discharge data, for the inpatient setting by DRG, this includes cases, days and billed charges. For the outpatient setting by revenue code, this includes visits and billed charges.

Because a hospital can determine at any time exactly how much additional revenue the software has generated each month, it works well with any charge master optimization or system that links the revenue cycle to the supply chain.  The software does not interfere with any system the hospital may already have in place or be considering for the future.

The product has a 17 year flawless compliance history of approved annual CMS and independent CPA audits. Never has one discrepancy, adverse or negative finding or comment been reported by the Medicare Fiscal Intermediary following annual field and desk audits. In addition, these hospitals have continued to receive “Unqualified Opinions” in their annual financial statements following audits by their public accounting firm.

Quest also offers client hospitals combined pre-billing pricing and budgeting. With this advanced tool, hospital revenue budgets take just a few hours to prepare. Once the Finance Department has determined operating expenses for the next year, and has allowed for a surplus or reserves, the Quest software will automatically develop and achieve the revenue budget required to meet the financial targets set by the hospital.