Site Map    Careers    Contact Us    Home
Provider Consulting Solutions' Home Choose Your Solution

Healthcare Reform

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.

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.

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

Education & Events

PCS Webinars

Provider Consulting Solutions, Inc.