Retrospective Re-Pricing Program

The Retrospective Re-Pricing program works to minimize occurrences of providers delivering DME equipment and services at the local retail level—instead of through the in-network provider. As some transactions leak outside the network, this continues to drive additional and unnecessary expenditures. Through the Retrospective Re-Pricing program, PMSI can bill in-network invoices directly at competitive contractual rates, with the confidence that the service was reasonable and necessary.

Out-of-network invoices are converted to in-network transactions, providing our clients with additional cost savings and control. PMSI currently holds a 91% successful conversion rate, rolling an additional 18% – 21% of average savings to our clients. We work with each client to develop a Retrospective Re-Pricing program that best suits their business needs.

Client Success Story

PMSI processed more than 47,000 in-network transactions during an annual period for one client—goals were to drive higher in-network penetration, recognize hard-dollar savings, and lower operational overhead costs—and they were met. Program results revealed the following:

• Redirected billing transactions represented $528,773
• Included a re-priced amount of $401,667
• Achieved hard-dollar in-network savings of $127,106 or 24%
• Converted 92% of all redirected billing transactions to in-network transactions