Bundled Price Development and Pricing Integrity Worksheet & Checklist for Surgical and Interventional Procedures

Today's quick post is to share a checklist for those determined to start developing bundled price surgery and other interventional procedures. I've been developing bundled price surgery since the 1990s for use in U.S. insurance, workers compensation and personal injury cases.

This worksheet and checklist are designed to help you create clear, fair, and competitive bundled pricing for your bundled price program while maintaining pricing integrity. It provides a structured approach to calculate costs, define inclusions and exclusions, and establish policies for exceptions.

I am frequently called upon to assist hospitals, ASCs and clinics with bundled priced surgery because of three things: the CFO or other Administrator isn't quite sure how to begin and is anxious about missing charges that could create losses to their organization. The second concern is about knowing their costs to market/advertise their product(s), deliver care, bill, collect, and pay the other providers at the conclusion of a case. The third is that they are unsure how to maintain compliance while selecting key surgeons, anesthetists, and other related, collaborating vendors to bundle into a case.

You'll use this checklist and worksheet by specialty, by procedure, by surgeon. There can be crossovers such as hand surgery, back and neck surgery, and plastic surgery depending on the specialist. Also, don't forget combined procedures that are actually comprise of two or more CPT codes.

For readers outside the USA, CPT codes are five-digits primary key for use in a database and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm. They were developed by and are proprietary to the American Medical Association and accepted by all U.S. insurers as a way to submit an invoice for services or to negotiate prices.

I hope you find it helpful.

If you'd like help with this project, I can assist you anywhere in the world, using any currency, at any destination. Call 800.727.4160 to get in touch.

Bundled Pricing Worksheet

1. Define the Procedure or Service

• Name of Procedure/Service: ___________________________
• CPT Code(s): _______________________________________
• Specialty: _________________________________________

2. List the Components of the Episode of Care

• Pre-Procedure:
• Procedure:
• Post-Procedure:

3. Define Inclusions

• Clearly list what is covered in the bundled price:

4. Define Exclusions

• List items not covered, such as:

5. Determine Policies for Exceptions

• Patients disqualified from the bundled price due to comorbidities.
• Procedures requiring modifications (e.g., high-risk patients).
• Protocol for handling complications during or after the procedure.

6. Calculate Costs for Each Component

• Surgeon Fee: $________
• Facility Fee: $________
• Anesthesia Fee: $________
• Imaging/Labs/Diagnostics: $________
• Post-Op Follow-Up Care: $________
• Rehabilitation Services: $________
• Total Estimated Cost: $________

7. Establish the Bundle Price

• Add a fair, pre-determined margin to cover overhead and ensure profitability.
• Final Bundled Price: $________
• Specify whether discounts or additional fees apply (e.g., cash-pay patients, out-of-state patients).

Pricing Integrity Checklist

1. Transparency

• Provide patients with a detailed breakdown of what is included in the bundled price.
• Explain exclusions and potential out-of-pocket costs upfront.
• Use clear, patient-friendly language to describe the pricing structure.

2. Fairness

• Ensure bundled prices are competitive within your market.
• Base pricing on actual costs plus a reasonable margin.
• Avoid hidden fees or unexpected charges.

3. Consistency

• Maintain consistent pricing across all patient groups (e.g., cash-pay patients, employer-directed care).
• Regularly review and update bundled prices to reflect changes in costs or services.

4. Communication

• Train staff to explain bundled pricing clearly and consistently.
• Provide written agreements or contracts detailing the bundle price and terms.
• Include a contact point for patients to address questions or concerns about pricing.

5. Documentation

• Keep detailed records of how bundled prices are calculated.
• Ensure all contracts with third-party administrators (TPAs), unions, or employers reflect the bundled pricing terms.

6. Monitoring and Adjustment

• Regularly review patient feedback to identify concerns about pricing.
• Adjust bundled pricing as needed to ensure alignment with costs, market trends, and patient expectations.
• Monitor profitability to ensure bundled pricing remains financially sustainable.

For help with this process, you might check out my new software, Bundlr?. Once you have all these data points entered into the software by surgeon, by location, and by CPT code, along with the margin you’d like to realize, the software outputs a price that has pricing integrity built in. To learn more about Bundlr? or arrange a demonstration of the software, call 800-727-4160.