The already complicated CMS Inpatient Prospective Payment System (IPPS), compounded by the constant changes brought on by health reform and the transition to ICD-10, has left healthcare professionals struggling to grasp the complexity of MS-DRG grouping and payment. With this updated workflow solution, providers, payers, consultants and regulators will gain a clearer understanding of the latest developments and regulations to ensure claims accuracy.
“We knew that by combining Wolters Kluwer's expertise with NHA's up-to-date IPPS data and logic we could take IPPS understanding to a new level,” said Maria Bounos RN, MPM, COC, CSPO, and Practice Lead for Coding and Reimbursement Solutions at Wolters Kluwer. “A high-level federal government office uses our Grouper to review claims. Specifically, they are looking to see whether providers are ‘gaming the system’ to increase their reimbursement. When providers use our tools, they are working with the some of the same solutions that federal regulators use to assess claims. Being on the same page as the government helps providers protect themselves before a claim is ever submitted to the CMS.”
The MS-DRG Grouper, Calculator & Analyzer empowers reimbursement professionals to:
- Understand how a claim will be grouped and paid in a single step. Group and calculate for any provider in the country, for any point in time over the past five years, and benchmark against national unadjusted and state/regional averages.
- Surface retroactive payment changes and quickly verify outlier eligibility. Service line management and contract negotiations become evidence-based with accurate, data that is difficult to glean from published CMS content and encoder systems.
- Quickly analyze Medicare Expected Payment, including per diem and ACA impact, using the batch grouper.
“Hospitals, health systems and accountable care organizations need be able to track and predict financial and clinical performance,” said Warren Brennan, Managing Partner of New Health Analytics. “This is especially true for bundled payments and some ACO schemes. The Analyzer lets you easily lookup and compare what Medicare would pay any hospital in the country.”
About New Health Analytics
New Health Analytics offers hospitals, ambulatory surgery centers, integrated delivery systems, health plans and physician organizations health information applications to support clinical integration. NHA provides day-to-day data analysis to help managed care companies, accountable care organizations and pay-for-performance systems succeed both clinically and financially. With customers in 32 states, the company's expertise in analytics and economics provides an organized approach to hospital data analysis.