Healthcare Reform
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NYS Medicaid's newly adopted
APR-DRGs are significantly more
complex than previous payment systems. Hospitals need to
ensure that they are capturing the proper SOI to ensure
accurate reimbursement. The APR grouper logic and relative
weights are very different than the familiar MS and AP DRGs.
There are new areas where improved clinical documentation
and coding can lead to higher SOI levels. Coding strategies
that were effective under other DRG grouping systems need
to be updated. PCS is now offering a
Complimentary Customized APR-DRG Hospital Profile.
To view a sample chart about Severity of Illness Distribution
from this profile click
here.
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In addition, New York State Medicaid
adopted the 3M's Enhanced Ambulatory Patient (EAPG or
APG) payment methodology for hospital outpatient
services. Reimbursement and compliant billing are directly affected
by correct coding and documentation. Payments for medical visits
now vary based on diagnosis coding and HCPCS/CPT codes are required
for all procedures, therapies and ancillaries. Operational issues
such as rate code selection and scheduling can also impact payment.
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Our team will identify your opportunities
- even in areas not traditionally the focus of your previous
Clinical Documentation Improvement Initiatives. Understand
your reimbursement opportunities:
- Data Analysis, Departmental Review, and Reimbursement
Modeling
- Coding and Billing Audits
- Operational Assessments
Once you understand how these reforms affect your hospital,
PCS will help you:
- Establish targets and focus areas
- Educate your team
- Monitor your progress
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