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Price Transparency

Price Transparency is now a requirement for hospitals. To avoid fines, hospitals need to produce a Machine Readable File (MRF) of all payer and plans reimbursement terms. Effective July 1, 2024, hospitals are required to use the “tall” or “wide” standardized formats as published by the Centers for Medicare and Medicaid Services (CMS). CMS requires that these files be updated at a minimum annually.

IRI can construct the MRF, and if needed, a shoppable services file.

Our process starts with analyzing all contract terms. Once all terms have been documented, an IRI consultant will begin constructing the file. Once complete, IRI will collaborate with you to ensure terms were interpreted correctly. Final deliverables will be sent in a format that can be uploaded to the hospitals’ website.

Machine Readable file in CMS approved format
Shoppable Services files constructed in a way that is consumer friendly (optional)

In addition to price transparency file creation, IRI can also help perform pricing analysis and create strategies to maximize reimbursement or understand competitive environment. IRI is committed to the highest quality product. In the unlikely event a CMS auditor finds an issue with the MRF, IRI will provide any corrections. Our goal is to provide you with the highest confidence in the integrity of your price transparency files.

If you’d like more information, please contact us and we’ll be pleased to discuss how we can help you.

TESTIMONIALS

“As a Critical Access Hospital undergoing conversion to Epic, we needed assistance in moving to the new platform. We engaged IRI for their Charge Master Services and were delighted with all aspects of their work. They are abundantly professional and quickly built confidence in their expertise with all of the teams involved in this project. The requests that we had of them ranged from Provider Based billing, to Operating room, to Pharmacy among others. We had a tight timeframe and they fit us in with supreme customer service and responsiveness. We will definitely use them again for future projects, as well as some ongoing services. So grateful to have found this wonderful group of Charge Master experts.”

"The Concord Hospital Revenue Integrity department engaged IRI to perform comprehensive CDM Reviews for all our facilities and service lines. We chose IRI, because unlike other firms, they commit to analyzing every single charge line. They delivered on that promise. The reports and files they returned were comprehensive, easy to understand, and thoroughly explained potential issues and opportunities. We also use the IRI Retainer Service to assist us in understanding complicated charging and billing rules as they come up. Jon and Julie are extremely knowledgeable and helpful. I highly recommend their services."

"We are incredibly satisfied with the exceptional Revenue Cycle services provided by Integrated Revenue Integrity (IRI). Julie Hall and her team demonstrated unmatched expertise, professionalism, and a commitment to exceeding our expectations. Their proactive approach, clear communication, and dedication to customer satisfaction made a significant positive impact on our project. IRI truly stands out in the industry, and we highly recommend them for top-notch service."

I would highly recommend IRI in an interim management capacity; they filled a critical staffing gap and performed much needed analysis on claims and denials. They took time to understand the objectives that were important to our revenue cycle and worked to target those areas of concern. When changes were recommended, they included well researched payer policy, supporting documentation, and alignment with industry best practice. Julie integrated seamlessly into the department, effectively worked with operational stakeholders in our organization, and assisted with knowledge transfer for the incoming manager to ensure a smooth transition. Julie’s leadership and expertise were valuable; we will utilize IRI should another need arise for interim management.

Integrated Revenue Integrity (IRI) provides an integrated suite of solutions to ensure that your facility is maximizing reimbursement in compliance with regulatory guidance.

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