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"The last thing we can afford to do is
ignore the impact of our biggest payor..."
"Harvest has found hundreds of thousands of
dollars in lost reimbursement from Medicare and Medicaid. It makes
understanding their complex payments easy."
VP, Business Development Saints Memorial
Medical Center
"What is the financial impact of changes in
Medicare on our operating budget...?"
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Medicare & Medicaid
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Feature Summary
» Handles every type of Medicare and state-specific
» Medicaid payment methodology
» Provides detailed modeling of proposed changes in Medicare
reimbursement
» Includes APC grouper
» Provides all data for cost report preparation and/or
PS&R analysis and validation
» Handles both technical AND professional billing
» Provides all information for A/R valuation and financial
statement purposes
» Includes CCI code bundling logic
» Includes RCC-based costing
» Also handles Industrial Accident (Worker's Comp) and Champus
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The Challenge:
Because most
hospitals have such significant government payor
utilization, hospital fiscal staff spends a considerable amount of time
dealing with the unique reimbursement issues these payors
present. The valuation of A/R for financial statements, annual cost
report preparation, payment accuracy and changes in reimbursement levels
all present significant challenges to hospitals. Fundamental management
technique dictates that this business be monitored and analyzed
accurately simply because it has such a significant impact on the
hospital's operating budget.
The
Solution:
Harvest provides a comprehensive tool to manage regulatory payors -- especially Medicare and Medicaid.
Having its origins in the first fully automated Medicare logging system
in the country, Harvest continues that tradition by compiling a detailed
database of claim and remitted payment data. It precisely
calculates expected payments and contractual allowances for ALL reimbursement schemes used
by Medicare & Medicaid, including:
- PPS
(DRGs)
- Outpatient
Prospective Payment (APCs)
- Durable
Medical, Orthotics and Prosthetics (DME)
- Rehab
Services (OT, PT, Speech)
- Screening
Mammography
- End
Stage Renal Dialysis (ESRD)
- Other
Diagnostic Fee Schedule
- Laboratory
Fee Schedule, including code bundling and profiling
- Radiology
Fee Schedule
- Resource
Utilization Groups (RUGs)
- Rehab,
LTC and Psych PPS
- PPS
Exempt Reimbursement
- Medicaid
Ambulatory Patient Groups (APGs)
- State-specific
Medicaid systems
- Physicians
Fee Schedule
The claim and payment information becomes a valuable
asset for cost report preparation, PS&R verification, third party
audit, interim and final financial statement preparation, monitoring
payment accuracy and budget preparation.
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Harvest Standard Reports commonly used to evaluate
Medicare data:
- Medicare Modeling Report
- CPT® Code by Payor
Comparison Report
- Remittance List Report
- Average Turnaround Days Report
- CMG Summary Report
- Payor Summary Report
- Recap Report
- RUG Summary Report
- Secondary Payor
Summary Report
- APC Utilization Report
- APC Utilization Index Trend Report
- Case Mix Index Report
- Case Mix Index Trend Report
Report samples are
provided separately.
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The
Challenge:
Accurately evaluating the effect proposed Medicare reimbursement
changes will have on the annual operating budget.
The
Solution:
Shortly after announced changes are published in the Federal Register,
they are incorporated into Harvest where they can be used to model their
financial impact using your actual claims experience. These changes
can include new DRG tables, APC tables, fee schedules and other
regulatory rule modifications. The Medicare modeling tool in
Harvest will calculate the financial result of proposed changes and
compare it to your current reimbursement level. These modeling
exercises also include RCC-based costing information for profitability
analysis. Medicare Modeling in Harvest is relatively quick and easy
to execute, and the results are very accurate so you can trust the
predictive value for your decision-making.
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