For most critical access hospitals, a full chargemaster review isn’t an annual task. It’s something that happens when there’s finally time, staff, and bandwidth to take it on, and for a hospital running lean, that time doesn’t come around often.
Titusville Area Hospital hadn’t completed a full chargemaster review in over a decade, which is the normal reality of a small team covering a lot of ground.
That changed when Titusville partnered with REDi Health through the Pennsylvania Office of Rural Health. The project began as a standard peer comparison, then shifted course once the team saw what would actually move the hospital’s bottom line. The result: a projected $200,000 in annual net revenue, four times what the hospital’s CEO had hoped for going in.
About Titusville Area Hospital
Titusville Area Hospital has served its corner of northwest Pennsylvania since 1900. It’s a 25-bed critical access hospital, part of the Meadville Medical Center system, serving a community of about 4,000 people and the surrounding area.
Around 80% of its patient population is on Medicare, reflecting an older population that leans heavily on the hospital for care.
The hospital also runs a swing-bed program that the VP of Revenue Cycle says patients specifically request after surgery or a hospital stay. At 25 beds, patients notice the difference: shorter waits for a CT or MRI than they’d get elsewhere, and the kind of attention a small facility can give that a bigger one can’t.
The Pivot That Paid Off
The project started as a standard chargemaster review: submit chargemaster and volume data, pick a peer group, and see how Titusville’s charges stacked up.
Partway through, an issue surfaced. Titusville is a critical access hospital, and blanket increases on high-Medicare-volume procedures wouldn’t have moved the needle. Medicare cost report rules mean a CAH gets paid more up front on those services, then pays much of it back later through cost report reconciliation. The net revenue gain would be a wash.
“We felt really horrible about it, but the REDi Health Team was fantastic,” Jill Neely, VP of Revenue Cycle at Titusville Area Hospital, said of the pivot. Titusville’s CEO was direct with our team about what he actually wanted: net revenue gain, not a bigger number on a chargemaster nobody reimburses at full price.
Therefore, our team reviewed the fee schedules of Titusville’s two largest commercial payers and compared them with current charges. Many commercial contracts pay the lesser of the billed charge and the fee schedule rate. Where Titusville’s charge sat below that fee schedule, the hospital was leaving real money on the table every time that procedure got billed.
That comparison narrowed a long list of potential increases to those that would actually move the bottom line.
The Result Blew Past the Target
The CEO had told the team he’d be satisfied with a $50,000 annual impact. The review came back projecting roughly $200,000 a year in net revenue gain.
“Pleasantly surprised,” Neely said. “We didn’t really have a high expectation, so when we saw that, it was very meaningful to us.”
The new charges went into effect on August 1. Titusville uploaded REDi Health’s final file directly into its system, with no manual line-by-line entry required.
“We were able to just upload those into our system without having to change every entry manually,” Neely said. “It was such an easy process.”
Neely expects to start seeing the dollar impact show up in payments within a month or two, and plans to track it by comparing this year’s commercial claim volume and payments against last year’s.
What Made the Chargemaster Process Work
The weekly touchbase calls were the real difference-maker. That’s where the CAH reimbursement issue surfaced, early enough to change course before the project went too far in the wrong direction.
“Without those weekly meetings, I think it would have been hard to recognize that we needed to pivot,” Neely said. “We probably wouldn’t have gotten a product that was as meaningful.”
The calls themselves stood out too, not as another obligation on the calendar, but as time that was actually useful. “Each call was beneficial. You learned something, you got information,” Neely said. “It wasn’t, ugh, I got another call, I gotta be on for an hour and just sit here and listen. It was very interactive.”
That willingness to adjust is core to how REDi Health works. Once it became clear that a blanket comparison-group review wouldn’t serve Titusville’s financial goals, the approach shifted to focus on the hospital’s specific payer mix. Every engagement gets that same flexibility, with a strategy shaped around the hospital in front of us rather than a fixed process applied the same way every time.
Neely also credited the review for going in without assumptions about which departments needed attention and which didn’t. “There’s no preconceived notions. They looked at all of our data, sifted through it all, and let the numbers do the talking.”
Asked what she’d tell another rural hospital considering a chargemaster review, Neely didn’t hesitate: “Absolutely worth it.”
What $200,000 Means for a 25-Bed Hospital
For a hospital Titusville’s size, Neely calls this kind of gain “found money,” money that shows up without changing expenses or volume.
That’s the difference between deferring an equipment upgrade and moving on it. Neely pointed to updated OR equipment and newer X-ray technology as the kinds of purchases that become easier to justify once a hospital knows the revenue is actually there, rather than hoping it might be.
For a critical access hospital serving an aging, largely Medicare- and Medicaid-enrolled population 30 to 35 miles from the nearest alternative, that margin is what keeps services in Titusville rather than routing patients elsewhere.
What This Looks Like for Your Hospital
Most rural hospitals haven’t touched their chargemaster in 4 to 5 years, sometimes a decade, and that’s a normal byproduct of running a small team with a lot on its plate.
REDi Health builds every chargemaster engagement around the hospital in front of us. There’s no standard playbook applied the same way twice. Some hospitals want a single, complete pass through their CDM; others want an ongoing maintenance relationship, whether that’s an annual comprehensive review, quarterly service-line checks, or a custom cadence built around their team’s bandwidth. Titusville’s own project shifted mid-stream once we understood what would actually move their bottom line, and that kind of adjustment is built into how we work, not an exception to it.
Communication runs through the entire process. Weekly working sessions, direct answers to direct questions, and no findings delivered as a surprise at the end. Hospitals see the data as we do, understand the reasoning behind every recommendation, and walk away able to explain and sustain the strategy long after the engagement wraps up.
If your hospital hasn’t reviewed its chargemaster in years, that’s the norm, not a problem to apologize for. It’s exactly the kind of engagement REDi Health was built for, so reach out to see what a review could find in yours.
