New decision support tool increases claims accuracy.
Wolters Kluwer Law & Business has partnered with New Health Analytics (NHA) to take the complexity out of Inpatient Prospective Payment System (IPPS) by developing the only stand-alone MS-DRG Grouper, Calculator & Analyzer on the market.
Before MS-DRG Grouper, Calculator & Analyzer, healthcare providers, payers, consultants and even regulators were left struggling to grasp the complexity of MS-DRG grouping. Additionally, confusing regulations and outdated pricer tools made payment overly complicated.
“We saw a need in the market for this kind of decision support tool,” says Maria Bounos RN, MPM, CPC-H, and Practice Lead for Coding and Reimbursement Solutions at Wolters Kluwer. “Revenue Cycle Specialists could not test grouping and diagnostic related group (DRG) scenarios to increase their claims accuracy as existing systems are either not transparent, too expensive, or cannot batch group claims in one simple workflow.”
Created to increase claims accuracy, the MS-DRG Grouper, Calculator & Analyzer provides the opportunity for consultants, cost report analysts, product line managers and regulators to perform a comparative analysis of multiple providers’ Medicare Expected Payment. It allows users to:
- Compare and benchmark national, state, regional and provider-specific reimbursement for any MS-DRG
- Reveal the impact of performance on measures like quality reporting, meaningful use, and readmissions
- Identify outlier eligibility and calculate payment increases
“An essential element of revenue cycle management and financial health is the ability to accurately calculate payments,” says Warren Brennan of New Health Analytics. “We have extensive experience with the pace of regulatory releases and the increasing complexity of the underlying algebra of CMS payments.”
“The timing of this launch couldn’t be better, as all inpatient coders need to practice ICD-10 coding and grouping to prepare for the implementation of ICD-10,” adds Bounos. “Providers need to model how a typical patient stay coded in ICD-9 would shift to a different MS-DRG when coded in ICD-10 in order to understand the related financial risk.”
Find out more about this SaaS tool from Wolters Kluwer, available through the Coding Suite and the Compliance Suite or as a stand-alone subscription. (http://www.wolterskluwerlb.com/health/product/coding-suite/coding-tools/ms-drg-grouper)
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.