1. How does the Quest Precision Pricing Software increase the hospital’s net revenue?

By unique / electronic modification of the pricing logic as the final billing step. For inpatient billing: the CDM charges are modified by Quest’s hospital-specific “severity-of - illness index” based on the DRG, generating the patient’s bill. For outpatient billing: the CDM charges are modified by Quest’s hospital-specific “site of service delivery-index” based on the revenue code, generating the patient’s bill. In-patient indexing logic is different from outpatient indexing logic. Both uniformly price all services to all patients regardless of payer.

Quest models itself after the CMS “relative weight” format introduced by CMS in 1986, but allows the hospital the advantage of applying the modifiers to ALL PATIENTS in ALL SETTINGS. Both are historically proven to be both accurate, ethical, and CMS “Provider Reimbursement Review Board (PRRB) decisions support the practice”. Quest has been examined for 17 years in annual CMS cost reports and independent CPA firm audits receiving “unqualified opinions” As a formula, the process looks like this:

Inpatients: CDM charge X “severity-of-illness index multiplier” = final charge.
Outpatients: Revenue Code X “site-of-service index multiplier” = final charge.

Patient charges are transferred electronically to the Quest computer in the hospital. Data transfer can be for an individual patient or batched to transfer groups of patient charges. This transfer may be in random sequence at any time or scheduled to transfer at any time sequence during the day. Quest software analyzes each patient charge. The software then applies your hospital-specific index values to each charge, and creates the appropriate revised billing.

Once Quest’s software modifies the charges, the system automatically updates the hospital’s own computer system, transfers the billing data to the hospital's billing station, and updates the general ledger. This entire process occurs in microseconds and DOES NOT delay billing time. The UB-92 billing form is then generated as usual and sent to the payer.

2. How does Quest provide Price Transparency for patient’s with requests for procedure cost quotes?

Immediately available to individual patient requests……even payer specific.  Quest Software provides the tools for payer-specific price quotes at the time of the patient request. Quotation Specialist enters the patient’s answers to a standard series of identity verification (SS, DOB, DL, hospital password, etc.) and general health questions (age, height, weight, smoker, diabetic, drug allergies, insurance ID, etc.). From those answers, the software calculates and displays to your Quotation Specialist the average current price of that procedure from the hospital and the estimated remaining patient responsibility…..even payer-specific….at the hospital’s option.

3. How will the Quest software increase or decrease standard reimbursement
from Medicare / Medicaid, or any other fixed-amount payer?

None at all. The software affects only non-fixed-payer net revenue, not fixed-payer reimbursement. There is no affect on revenue received from any HMO, PPO, Managed Care or Capitation Plan, that have fixed-payer contracts. 

4. What are the sources from which Quest had developed the basis for the statistical
pricing index multiplier system?

Estimating the net annual revenue increase available:
1. AHA (American Hospital Association)……..……..…….….updated annually.
2. Solucient…………………………………………………….updated annually.
3. Quest’s in-house database: Consisting of pricing data of US hospitals,
representing> $ 27 billion in hospital charges…………….updating continuous.

Validating the estimate: Analysis of 12 mos. of actual discharge data.
4. Medicare Cost Reports……… … updated annually or more often as required
5. CMS (Center for Medicare and Medicaid Services)
data on blended rates and area wage index………………...updated annually.
6. Hospital’s own case and payer mix………………………...updated annually.
7. Metropolitan Statistical Area….(hospital’s specific locale)..updated annually.

5. If the hospital is doing a good job regulating the Chargemaster, how does the hospital benefit from using the Quest Precision Pricing Software?

Quest’s Precision Price Indexing is inserted AFTER all CDM items have been
validated in-house and are correctly in the system. Quest is compatible with and
enhances the value of ALL pre-billing CDM validation systems including:

MedAssets……Ernst & Young…….Deloitte & Touche…..PARA (Ripper & Assoc.)
Craneware…...The Rybar Group…The Horne Group……Cleverly & Associates
and other custom Chargemaster validation software.

The Quest software is a statistical pricing system, electronically preselecting those areas of patient service from which the hospital can benefit. Only an electronic, computer – analysis, selection system can accomplish setting the index modifiers with accuracy and efficiency, which must be hospitals. Making periodic “across the board” increases in the CDM or even CDM charge-validation accomplish any “severity of illness” inpatient pricing or any “site of service delivery” pricing components for outpatients.

The established charges on the Chargemaster (plus several other hospital-specific factors, proprietary to the Quest operating system) are initially used to establish the Quest System “index values or multipliers”.

6. Is it legal to charge inpatients and outpatients different fees for the same services, such as: X-Ray, MRI, CAT scans, medications.

Yes. CMS…. Provider Peer Review Board …“Thus, it appears settled that a hospital may charge outpatients a different fee for a service than is charged to inpatients, as long as it does not differentiate by payer source.”

Statutes do not prohibit charging different amounts for services in the inpatient setting with different severity of illness (DRG/s). Statutes do not prohibit charging a different amount in the outpatient setting from the inpatient setting. Both current independent legal opinions from a leading healthcare law firm, Venable LLP, Baltimore, MD verifies this

7. Is Quest in compliance with CMS, OIG, and HIPAA guidelines?

Yes: Compliance Validation section gives the precise details.
CMS compliance: Quest software does not affect the standard reimbursement payments received from Medicare / Medicaid because the DRG assignment is not altered and all patients are billed uniformly for the same illnesses.
OIG compliance: The software is compatible with the CMS 837 format (the computer language required by the federal government for billing) and with the HIPAA X-12 format (the 12 universal computer languages required for data transmission).
HIPAA: Quest complies with HIPAA (the Health Insurance Portability and Accountability Act). Quest software operation never needs any patient name, social security number or any other patient identity.
Uniform pricing: Quest software uniformly prices all patient bills, regardless of the payer.

Quest software operation will not, and cannot change or alter any reimbursement based on a hospital-assigned DRG. In the alternative, Quest’s product will identify, refuse, and return an alert to the hospital of any and all Medicare, Medicaid patient bills input into the Quest software, without a hospital-assigned DRG.

HIPAA guidelines are available at www.hipaa.org and/or www.hipaaadvisory.com.

8. How does the Quest software effect hospital contracts that are discounted to specific payers?

Quest software generates additional revenue only from non-fixed payers. The Quest software will not affect standard reimbursement payments of Medicare or Medicaid or the revenue payments from any fixed-payer contract. Quest software will generate additional net revenue from any “non-fixed payer contract,” at the same time, reducing the contractuals of the fixed payers.

9. How often are Quest’s index values changed for my hospital?

Annually or immediately (1) as any change is mandated for a specific DRG disease and/or revenue code or (2) with any regulatory or statute change.

10. How does the Quest software interface or mix with the hospital’s HIS system?

Automatically: The hospital will enter charge data and other patient information as usual. This may be done individually or in batches. Data entry may be done at random times or scheduled at any given time. Quest software automatically accesses the input charges, analyzes the treatment setting, applies the Quest indexes and returns the pricing data to the billing station. The new statistically-adjusted pricing is processed into the hospital’s own HIS accounting system just as it is done now. Billing continues as normal. No change in the UB-92

11. Is the Quest System compatible with our Hospital Information System?