Every tool
All 30 tools
Grouped as in the menus at the top of every page. Each opens on a saved sample with its answer on screen; change any input and price your own.
Every tool, by task
Price a claim
- Inpatient claimA hospital stay by DRG, priced as Original Medicare, MA out-of-network or a percent of Medicare, with every step shown.
- Outpatient claimA hospital outpatient claim line by line, with packaging, discounting and edits, or one code’s APC or ASC rate.
- Professional claim837P lines by code and ZIP at any place of service, with modifiers, co-surgery and labs.
- AnesthesiaAn anesthesia case: base units, time units and the modifier’s share, priced on the professional claim.
- Skilled nursingA skilled nursing stay: the daily rate by day of stay, coinsurance days and Part B.
- Home healthA 30-day home health period, with the low-visit test and the wage index where care was given.
- Post-acute careLong-term care, rehab and psych hospital claims, hospice and dialysis, with every step shown.
- Medicaid by stateInpatient stays by APR-DRG in New York, Texas, Colorado, Virginia and Washington, plus state rate codes and fee schedules.
- Maryland hospitalsA Maryland hospital claim at its approved rates, and what Medicaid, managed care, Medicare and commercial plans each pay.
- MA out-of-networkWhat a Medicare Advantage plan owes a hospital it has no contract with, for an inpatient stay.
Check claims
- Payment varianceAn 835 matched to its claims: paid against the Medicare amount, with the likely cause of each underpayment or overpayment. For a contracted payer’s remits, use Batch repricing with a saved contract.
- DRG validation837I, FHIR or UB-04 claim files, each regrouped and checked against its billed DRG; outpatient bills get line edits.
- Batch repricingA CSV of claims priced at once, against Medicare or a saved contract, with the largest variances against paid first.
- Verify a priceOne inpatient claim priced here and by the official pricer, component by component, with the likely cause of any gap.
- Claim system auditA guide: how to check the Medicare rates your claim system pays against an independent second price, claim type by claim type.
- Claim editsScreen a hospital outpatient claim’s codes for pair edits, facility unit limits, packaging and add-on rules.
Model a contract
- Contract modelingInpatient contract terms over a DRG mix (percent of Medicare, case rates, per diems, stop-loss, lesser-of), from either side of the table.
- Contract libraryYour saved contracts by hospital CCN or billing TIN, applied on the inpatient claim, Batch repricing and DRG validation.
- Compare DRG ratesInpatient DRG payments side by side: up to four DRGs at one hospital, one DRG at four hospitals, or year over year.
- Site-of-care compareOne procedure’s payment in a hospital outpatient department and in an ASC, adjusted to a hospital.
Coding and CDI
- CDI reviewHow a documented, clinically supported condition would change the DRG and payment, with possible gaps from a note and open-ended queries.
- DRG grouperICD-10 codes to a DRG: the grouping path, the code that set the severity, and the other DRGs in its family.
- How grouping worksStep through grouping live: body system, surgical or medical path, CC and MCC.
Look up
- Provider lookupA hospital, post-acute provider or NPI: wage index, payment factors and the change from last year’s rates.
- DRG benchmarksNational and state inpatient payments by DRG, with a case-mix-free index for every state.
- DRG directoryA page for each DRG: national payment, stay length and volume.
- Rate updatesWhich rate releases each price uses, and the date each took effect.
- Accuracy study5,000 inpatient claims priced here and by the official pricer: all 5,000 within $1.
- Payment newsMedicare and Medicaid payment changes, each explained with a worked claim.
- GuidesHow-tos on CC and MCC, present-on-admission flags, and outpatient vs ASC pricing.