Who Should Use This Service
Health plans that reimburse facility claims based on CMS’ OPPS reimbursement methodology. APC pricing can be effective if claims are paid at straight APC pricing or a percentage rate of APC.
Process for Evaluation of Client’s Claim
HealthMind will evaluate a minimum six-month period of paid claims data to assess the potential savings relevant to Client’s lines of business. During this process, HealthMind will work with Client to validate the completeness and integrity of the data with respect to the requirements of the audit services, with particular attention to the data regarding contract specificity. A high-level assessment of Client’s payment policies and contracts will be conducted to ascertain what exclusions or customizations, if any, need to be put in place prior to deployment. HealthMind will collaborate with Client to determine best strategies for integrating data mining results into their offset process in order to reduce cost to Client, efficiency for the provider and so no manual intervention by client is required to accept HealthMind audit results. HealthMind will work with client to validate results with respect to provider contracts and payment policies prior to “go-live”.
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