Diagnosis Related Grouping (DRG) Pricing

 

 

Pre- and Post Pay Inpatient Claims

UNPARALLELED SYSTEMS

HealthMind provides several types of pricing services including a fully integrated pre- and post-pay DRG pricing. The service is delivered through our new delivery platform ReThink™, which is built on a continuous looped architecture with dynamic discovery. As a result, we are able to dig much deeper into all coding rules to ensure maximum compliance and payment accuracy.

Embedded into ReThink™ logic, the DRG pricer uses CMS raw data tables to correctly price DRG claims. When CMS releases updated raw data tables, the HealthMind pricer is automatically updated within 24-48 hours. ReThink™ automatically selects the appropriate CMS version using a patient’s discharge date. This ensures that the correct grouping, editing and pricing are applied. While it is very complex to apply the correct pricer, ReThink™ stores a five-year history of CMS versions to ensure all claims are priced correctly and allowing HealthMind to fully exploit the applicable coding rules.

 

COMPLETE METHODOLOGY

The integrated Grouper, Editor, Pricer within Rethink™ encompasses all aspects that will affect the final pricing of a claim. Where other pricing services will simply price a DRG, HealthMind takes into account all diagnosis and procedure codes, along with other factors such as POA indicators, to determine the correct pricing. This ensures not only that the DRG is priced correctly, but that it is also the appropriate DRG to begin with. The Grouper, Editor, Pricer allows for quick batch processing or can even be used on a claim-by-claim basis. Both pre-and post-pay pricing audits are handled automatically through our proprietary continuous-looped architecture offering our clients a totally seamless environment.

 

How it works:

  • Developed by our team of IT specialists in collaboration with our coding and clinical experts
  • Offered through a fully integrated pre-and post-pay platform
  • Stores a five-year history of CMS versions
  • Eliminates pricing errors
  • Provides a compelling and easy to understand ROI
 
 

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